Gastrointestinal Non-Hodgkin Lymphoma: A Multifaceted Malady

Abstract

Lymphomas account for approximately 5% of human malignancies and are classified as Hodgkin or non-Hodgkin variants. Non-Hodgkin lymphomas (NHL) constitute nearly 90% of all lymphomas, with diffuse large B-cell lymphoma (DLBCL) being the most prevalent histological subtype. Although primarily nodal, extranodal involvement is common in NHL, with the gastrointestinal (GI) tract being the most frequently involved extranodal site. Lymphomas constitute only 1–4% of gastrointestinal malignancies, with appendix being an exceedingly rare site of involvement. Lymphomas are conventionally staged utilizing the Ann-Arbor system and risk categorized per the International Prognostic Index (IPI). The Dawson’s criteria differentiate primary versus secondary gastrointestinal lymphoma. Diagnosis of lymphoma relies heavily on conventional and immune stained histopathology. Surgery offers the best therapeutic option in localized disease, while chemotherapy is preferred in diffuse or non-resectable diseases. We present a unique and an exceedingly uncommon combination of recurrent DLBCL with appendicular involvement, gastrointestinal hemorrhage, hepatic metastases, and obstructive jaundice. This case highlights the diagnostic challenges posed by extranodal lymphoma, particularly in rare sites such as the appendix. It underscores the critical role of multimodal imaging, endoscopic intervention, and immunohistochemical profiling in diagnosing, staging, and managing intraabdominal lymphomas.