Intestinal Lymphoma Symptoms
Intestinal lymphoma presents with diarrhea, abdominal pain, fever, weight loss, gastrointestinal bleeding, and signs of obstruction or perforation. 1
Primary Clinical Manifestations
The symptoms of intestinal lymphoma are notably nonspecific and often mimic other gastrointestinal conditions, making early diagnosis challenging:
Core Symptoms
- Abdominal pain or discomfort occurs in 72-76% of patients and represents the most common presenting complaint 2, 3
- Diarrhea is present in 7-13% of cases and may be associated with malabsorption features 1, 2, 3
- Weight loss affects approximately 33-36% of patients and can be marked 2, 3
- Gastrointestinal bleeding manifests in 15-56% of patients, often presenting as anemia or bloody stools 4, 2, 3
- Fever occurs in approximately 9% of cases 1, 2
Acute Complications
Critical warning signs require immediate evaluation:
- Bowel obstruction develops in 11-14% of patients and represents a surgical emergency 2, 3
- Intestinal perforation is rare (1.2%) but life-threatening 2
- Intussusception can occur as an acute complication 4
Additional Features
- Abdominal mass is palpable in approximately 26% of patients, particularly with larger tumors 2
- Anemia is present in 54% of cases, often secondary to chronic bleeding 2
- Hypoproteinemia affects 41% of patients, reflecting malabsorption or protein-losing enteropathy 2
- Nausea and vomiting occur in approximately 32% of cases 2
Anatomic Distribution and Age Patterns
The small intestine is the predominant site for primary intestinal lymphoma (excluding gastric), with 90% occurring in the small bowel, particularly within 100 cm of the ileocecal valve. 3
- Patients with intestinal lymphoma present at a younger age (mean 42 years) compared to gastric lymphoma (mean 53 years) 2
- The incidence increases significantly after age 40, with 87% of cases occurring in this age group 3
Diagnostic Pitfalls
The nonspecific nature of symptoms leads to high misdiagnosis rates, with clinical diagnosis achieved in only 31% of cases initially. 2
Common mimics include:
- Inflammatory bowel disease (Crohn's disease) 1
- Infectious enteritis 1
- Celiac disease complications 1
- Other malignancies 5
Multi-site biopsies with immunohistochemistry are essential, as endoscopic biopsy confirmation reaches only 74% even with adequate sampling. 2
Pathologic Patterns
- Diffuse large B-cell lymphoma (DLBCL) is the most common histologic type in intestinal lymphoma (46%), contrasting with gastric MALT lymphoma 3
- T-cell lymphomas carry significantly worse prognosis than B-cell types (1-year survival 36% vs 89%) 3
- Monoclonal T-cell populations on histology confirm the diagnosis 1
Prognostic Indicators
Clinical stage and cell origin are independent prognostic factors, with Stage I-II disease showing 87% 3-year survival versus 0% for Stage III-IV. 3