Authors: Ahmed Qotb , Meshaal Alenezi , Ahmed Khairy , Mohammed AlJasmi

Abstract

Background: Mucosa-associated lymphoid tissue (MALT) lymphoma is a rare variant of extranodal marginal zone B cell lymphoma occurring at mucosal sites. Gastric MALT lymphoma is well-described, but non-gastric MALT lymphomas, particularly small intestinal, ceacal, and appendiceal MALT lymphoma, are rare and present diagnostic problems. Intestinal MALT lymphoma is frequently diagnosed late and can be associated with nonspecific symptoms in patients.
Case presentation: A 69-year-old female with diabetes mellitus, hypertension, and hypothyroidism, admitted to the emergency room for 24 hours with colicky lower abdominal pain and vomiting, without bowel movements. Abdominal distension and right iliac fossa tenderness were noted on clinical examination. Imaging, however, suggested a closed-loop obstruction of a twisted segment of the ileum. A laparoscopic right hemicolectomy with resection and anastomosis was carried out on the patient. Extranodal marginal zone lymphoma of MALT type arising from the terminal ileum, cecum, and appendix with ischemic changes
was identified by histopathological analysis of the resected specimen.
Conclusion: The importance of considering MALT lymphoma in the elderly with bowel obstruction, without an established chronic inflammatory or autoimmune condition, is emphasized in this case. Mechanical obstruction requires surgical resection, but systemic therapy is the treatment of choice for disseminated disease. Future research should address the role of molecular diagnostics and targeted therapies in non-gastric MALT lymphoma to enhance early detection and management programs.

Keywords: extranodal marginal zone lymphoma, gastrointestinal lymphoma, intestinal obstruction, malt lymphoma, case report