A case of malignant lymphoma diagnosed by capsule endoscopy

Abstract

Recently, capsule endoscopy has evolved as a non-invasive method for examining obscure gastro-intestinal bleeding (OGIB) in the gastrointestinal tract. Herein we report a case of malignant lymphoma which was diagnosed by capsule endoscopy.
A 68-year-old man with atrial fibrillation felt dizzy and was diagnosed with anemia (Hb 8.2g/dl). Gastrointestinal bleeding was detected by fecal occult blood test, and the patient was referred to the department of gastroenterology. Upper endoscopy and colonoscopy were unable to identify the source of the bleeding. To further investigate the OGIB, the capsule endoscopy test was selected, showing a type 2 tumor at the distal ileum. Single-balloon enteroscopy showed a near-circumferential tumor and stenosis. The histological findings of the tumor with single balloon enteroscopy contained only lymphoid cell lines, hence the tumor could not be diagnosed as malignant lymphoma. A partial ileal resection of the tumor was performed. Histological diagnosis of the resected lesion was diffuse large B-cell lymphoma.
It is reported that between 2 and 9％ of small intestinal tumors are diagnosed by capsule endoscopy during investigation of OGIB. We conclude that capsule endoscopy may be useful for the diagnosis of OGIB potentially leading to the discovery of malignant lymphomas.