PMC4729516_01
Plain abdominal radiographs taken in the emergency room 3 days before visiting the outpatient clinic showed mild to moderate ileus without definite mechanical obstruction. (A) Erect view. (B) Supine view.
jkms-31-321-g001.jpg
PMC4729516_01_jkms-31-321-g001.jpg
F1
After simple abdominal radiographs showed mild ileus in the lower abdomen (Fig. 1), an evacuation enema relieved her symptoms, with the expulsion of feces and gas.
Abdominal ultrasonography of the right upper abdomen. (A) An ileocolic-type intussusception was found with a crescent-shaped hypoechoic portion (arrows). (B) Enlarged lymph nodes (*) along the intussusceptions.
jkms-31-321-g002.jpg
PMC4729516_01_jkms-31-321-g002.jpg
F2
Ultrasonography (Fig. 2) revealed an ileocolic-type intussusception that contained crescent-shaped hypoechoic spots, suspected to be the leading cause, and enlarged mesenteric lymph nodes.
Abdominal computed tomography. (A) A 3-cm, crescent-shaped (arrow), low-density lesion at the top of the intussusception. (B) Ileocolic-type intussusception (arrow).
jkms-31-321-g003.jpg
PMC4729516_01_jkms-31-321-g003.jpg
F3
Abdominal computed tomography revealed an ileocolic-type intussusception with 3-cm, crescent-shaped, low-density lesions at the top of the intussusceptum and small lymph nodes along the intussusception (Fig. 3).
Laparoscopy view showing the intussusception. Distal ileum (a) is pulled into ascending colon (b), forming ileocolic type intussuception (arrow).
jkms-31-321-g004.jpg
PMC4729516_01_jkms-31-321-g004.jpg
F4
Grossly, no ischemic change of the intussuscepted bowel was observed and the appendix appeared normal (Fig. 4).
Gross and microscopic findings of the resected tissue. (A) Gross view of the formalin-fixed hemicolectomy specimen including ileum, cecum and appendix showing an ill-defined ulcerative lesion (arrow), measuring 5.5 x 4.0 cm. (B) The terminal ileum shows ulceration with diffuse tumor cell infiltration (arrow) in the mucosa and proper muscle layer in a low-magnification view (H&E stained, x 20). (C) The tumor cells have large vesicular nuclei with prominent nucleolus and thick nuclear membrane (H&E stained, x 400). (D) The subserosa and serosa of the terminal ileum show fibrosis and chronic inflammatory cell infiltration (arrow) admixed with tumor cell infiltration (Masson trichrome stained, x 20).
jkms-31-321-g005.jpg
PMC4729516_01_jkms-31-321-g005.jpg
F5
Histopathologically, it showed features of diffuse large B-cell lymphoma (Fig. 5).