Primay Malignant Lymphomas Arising from the Ileum and the Ampulla of Vater: Report of a Case

A 71-year-old man was admitted with complaints of right lower quadrant pain and abdominal fullness. Barium enema and computed tomography (CT) scan demonstrated a tumor in the terminal ileum. There was no enlargement of superficial lymph nodes. Colonofiberscopy revealed a narrowing of the terminal ileum and biopsy specimens showed evidence of B-cell lymphoma. Laparotomy was performed in view of the small bowel obstruction. An elastic firm tumor, measuring 5.2 by 4.5 cm, was found in the terminal ileum, and the regional mesenteric nodes were enlarged. lleo-cecal resection with dissection of lymph nodes was performed. The resected specimen revealed a diffuse, B-cell lymphoma with 1gM heavy-chain and kappa light-chain restrictions. The patient developed obstructive jaundice 2 weeks after surgery, and CT scan demonstrated tumor in the ampullary region of the duodenum. Endoscopic examination showed an ulcerated tumor in the ampulla of Vater and biopsy specimen again showed B-cell lymphoma. Chemotherapy with cyclophosphamide, prednisolone, adriamycin and vincristine was effective and complete remission was achieved. To our knowledge, this is the first case of simultaneous occurrence of malignant lymphomas in the ileum and the ampulla of Vater