Intestinal Lymphoma: Recognizing Symptoms and Advancing Diagnosis for Better Outcomes

Intestinal lymphoma, though rare, presents clinical features that closely resemble colorectal cancer, often leading to delayed diagnosis. In the early stages, many patients remain asymptomatic or experience only mild, nonspecific symptoms such as occasional abdominal discomfort or occult blood in the stool. These subtle signs are frequently overlooked or attributed to less serious gastrointestinal issues like irritable bowel syndrome or gastritis.

Progressive Symptoms That Signal Advanced Disease

As the disease progresses and tumors grow larger, more pronounced symptoms begin to emerge. Persistent abdominal pain becomes common, often accompanied by changes in bowel habits including chronic diarrhea or episodes of bloody stools. In some cases, tumor mass can obstruct the intestinal lumen, leading to partial or complete bowel obstruction—manifesting as nausea, vomiting, bloating, and inability to pass gas or stool.

More severe complications may develop if the condition is left untreated. Patients might experience perforation of the intestinal wall, resulting in acute peritonitis—a life-threatening emergency. Systemic "B symptoms" associated with lymphomas, such as unexplained high fever, drenching night sweats, generalized pruritus (itching), and significant unintentional weight loss, may also appear, indicating widespread disease activity.

Diagnostic Pathways and the Role of Advanced Testing

Accurate diagnosis of intestinal malignant lymphoma typically begins with endoscopic evaluation. During colonoscopy or enteroscopy, suspicious lesions are visualized and biopsied for histopathological analysis. However, due to the variable location of lesions—especially in the small intestine—some cases require surgical intervention for definitive tissue sampling.

The Importance of Immunophenotyping and Molecular Profiling

Once tissue is obtained, immunohistochemistry plays a crucial role in confirming the diagnosis and distinguishing lymphoma from other malignancies. This technique identifies specific protein markers on immune cells, helping classify the lymphoma subtype—such as diffuse large B-cell lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma.

Furthermore, advanced molecular testing—including gene rearrangement studies and next-generation sequencing—allows for precise subtyping and risk stratification. These insights not only enhance diagnostic accuracy but also guide personalized treatment strategies, improving long-term prognosis and response to therapy.

Early recognition of atypical gastrointestinal symptoms, combined with timely endoscopic investigation and comprehensive pathological workup, is essential for diagnosing intestinal lymphoma before complications arise. Increased awareness among clinicians and patients alike can lead to earlier interventions and better clinical outcomes.