An Exophytic Ileocecal Mass: Diffuse Large B-Cell Lymphoma Diagnosed by Colonoscopic Biopsy

Edras Samuel Hernández Musús; Julia Milagro Ovalle Quiñonez; Nadhikrishna Samayoa González; Luis Fernando Sandoval García; Dania Anaberta Campos García; Carlos Paredes Amenábar; Lizza Daniela Paz García

GI Endoscopy · 2 min read

An Exophytic Ileocecal Mass: Diffuse Large B-Cell Lymphoma Diagnosed by Colonoscopic Biopsy

A lobulated, exophytic ileocecal mass should not automatically be approached as adenocarcinoma. Adequate targeted biopsies established DLBCL before treatment planning.

ByEdras Samuel Hernández Musús, MD,Julia Milagro Ovalle Quiñonez, MD,Nadhikrishna Samayoa González, MD,Luis Fernando Sandoval García, MD,Dania Anaberta Campos García, MD,Carlos Paredes Amenábar, MD andLizza Daniela Paz García, MD

**Figure 1A:** Exophytic endoluminal lesion arising from the ileocecal valve.

Experienced teaching points

Clinical Pearls

An exophytic and lobulated ileocecal mass should prompt lymphoma in the differential diagnosis; adequate targeted biopsies are essential before definitive treatment planning.

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A 63-year-old man with no relevant comorbidities presented with 6 months of generalized abdominal pain, a 25-lb unintentional weight loss, and nocturnal fever. Laboratory testing showed microcytic hypochromic anemia with hemoglobin of 10.4 g/dL, low serum iron, and elevated lactate dehydrogenase of 490 U/L. Contrast-enhanced abdominal CT demonstrated an infiltrative mass involving the cecum and right colon, with extrinsic ureteral compression and right hydronephrosis. The appearance was concerning for an ileocecal malignancy, with lymphoma remaining in the differential diagnosis.

Colonoscopy revealed a large exophytic, endoluminal lesion arising from the ileocecal valve. Its surface was irregular and lobulated, with marked distortion of the local anatomy, while the remaining examined colonic mucosa was unremarkable. Multiple targeted biopsies were obtained.

Irregular lobulated surface of the ileocecal lesion — **Figure 1B:** Irregular, lobulated surface with distortion of the local anatomy. Multiple targeted biopsies were obtained.

Histopathology showed infiltration of the lamina propria by medium-to-large atypical lymphoid cells. Immunohistochemistry was positive for CD20 and supported a germinal-center phenotype; CD10 expression and Ki-67 nuclear labeling were also demonstrated. The findings established diffuse large B-cell lymphoma (DLBCL) without a double-expressor phenotype. Baseline PET/CT demonstrated metabolically active thickening of the cecal/ileocecal region.

**Figure 2A:** CD10 immunohistochemistry.

**Figure 2B:** Ki-67 immunohistochemistry.

Baseline staging coronal CT — **Figure 3A:** Baseline staging PET/CT, coronal CT.

Baseline staging coronal PET — **Figure 3B:** Coronal PET.

Baseline staging coronal fused PET/CT — **Figure 3C:** Coronal fused PET/CT. Thickening of the cecal/ileocecal wall with increased metabolic uptake, consistent with active lymphomatous involvement.

The patient was referred to Hematology and received six cycles of R-CHOP. Follow-up PET/CT showed disappearance of the previously hypermetabolic intestinal lesions, consistent with a complete metabolic response.

Discussion

The practical lesson is that a lobulated, exophytic ileocecal mass should not automatically be approached as adenocarcinoma. Colorectal lymphoma may involve the ileocecal region and can present with a polypoid or mass-like morphology. Careful endoscopic inspection and adequate targeted biopsies can establish the diagnosis before definitive treatment planning.

References

Yachida T, Matsuda T, Sakamoto T, et al. Endoscopic features of colorectal lymphoma according to histological type. JGH Open. 2022;6(4):257-262.
Vetro C, Romano A, Amico I, et al. Endoscopic features of gastro-intestinal lymphomas: from diagnosis to follow-up. World J Gastroenterol. 2014;20(36):12993-13005.
Lightner AL, Shannon E, Gibbons MM, Russell MM. Primary gastrointestinal non-Hodgkin's lymphoma of the small and large intestines: a systematic review. J Gastrointest Surg. 2016;20(4):827-839.

About the authors

Edras Samuel Hernández Musús, MD

Resident, Gastroenterology and Digestive Endoscopy

Hospital General de Enfermedades, IGSS; Universidad de San Carlos de Guatemala

Edras Samuel Hernández Musús, MD, is a resident in the Gastroenterology and Digestive Endoscopy Residency at Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS) and Universidad de San Carlos de Guatemala.

Published work includes a study of pancreatic cancer survival and palliative care in Guatemala (OncoDaily Medical Journal, 2025). ORCID: 0009-0003-7049-7059.

Julia Milagro Ovalle Quiñonez, MD

Pediatric Pathologist

Department of Pathology, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala

Julia Milagro Ovalle Quiñonez, MD, is a pediatric pathologist in the Department of Pathology at Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS) in Guatemala.

Co-author of dermatopathology case reports on PIEL-L Latinoamericana, including exogenous ochronosis, disseminated histoplasmosis, and sebaceous carcinoma.

Nadhikrishna Samayoa González, MD

Gastroenterologist

Gastroenterology and Digestive Endoscopy Unit, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala

Nadhikrishna Samayoa González, MD, is a gastroenterologist in the Gastroenterology and Digestive Endoscopy Unit at Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS) in Guatemala, and a member of Guategastro, the Guatemalan Association of Gastroenterology, Hepatology, and Digestive Endoscopy.

Luis Fernando Sandoval García, MD

Gastroenterologist and Endoscopic Ultrasound Specialist

Gastroenterology and Digestive Endoscopy Unit, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala

Luis Fernando Sandoval García, MD, is a gastroenterologist in the Gastroenterology and Digestive Endoscopy Unit at Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS) in Guatemala, with a focus on endoscopic ultrasound and liver elastography.

Medical degree, Internal Medicine, and Gastroenterology and Endoscopy training at Universidad de San Carlos de Guatemala (USAC); advanced endoscopic ultrasound training at the Instituto Nacional de Cancerología (INCan), Mexico City. Member of the Asociación de Medicina Interna de Guatemala, Guategastro, and the Asociación Hepato-Pancreato-Biliar de Guatemala.

Dania Anaberta Campos García, MD

Gastroenterologist

Gastroenterology and Digestive Endoscopy Unit, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala

Dania Anaberta Campos García, MD, is a gastroenterologist in the Gastroenterology and Digestive Endoscopy Unit at Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS) in Guatemala, and a member of Guategastro, the Guatemalan Association of Gastroenterology, Hepatology, and Digestive Endoscopy.

Carlos Paredes Amenábar, MD

Gastroenterologist, Advanced Endoscopy and IBD

Gastroenterology and Digestive Endoscopy Unit, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala

Carlos Paredes Amenábar, MD, is a gastroenterologist in the Gastroenterology and Digestive Endoscopy Unit at Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS) in Guatemala, with advanced specialty training in therapeutic endoscopy and inflammatory bowel disease. The unit runs an inflammatory bowel disease clinic for patients with ulcerative colitis and Crohn disease on biologic therapy.

He trained in internal medicine, then in gastroenterology at Hospital 20 de Noviembre and Hospital General de México Dr. Eduardo Liceaga in Mexico City.

He also leads Gastroendosco, a private gastroenterology clinic in the Medika 10 building, and is on the Centro Médico staff in Guatemala City. He has spoken on colorectal cancer screening on the Entre Médicos podcast.

Lizza Daniela Paz García, MD

Hematopathologist

Department of Pathology, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala

Lizza Daniela Paz García, MD, is a pathologist with a focus on hematopathology in the Department of Pathology at Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social (IGSS) in Guatemala, and is on the Centro Médico medical staff in Guatemala City.

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About the authors

Edras Samuel Hernández Musús, MD

Julia Milagro Ovalle Quiñonez, MD

Nadhikrishna Samayoa González, MD

Luis Fernando Sandoval García, MD

Dania Anaberta Campos García, MD

Carlos Paredes Amenábar, MD

Lizza Daniela Paz García, MD

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