CASE REPORT 
Annals of Nuclear Medicine Vol. 7 NO. 3, 179-181, 1993 

Gallium-67 scintigraphy in an adult intussusception caused by malignant lymphoma 

Hitoya OHTA,* Tomoo KOMIBUCHI,* Yasuhide OHTA** and Kohzo SHIZUKI*** 

* Department ofLaboratories, Osaka Red Cross Hospital, Osaka * * Department of Internal Medicine, ***Pathology, Wakayama Red Cross Hospital, Wakayama, Japan 

A rare case of adult intussusception caused was reported. In spite of the cecum lesion, right epigastrium. This finding was useful due to ML. by malignant lymphoma (ML) of the cecum strong 67Ga accumulation was located in the in suggesting the presence of intussusception 

Key words : Malignant lymphoma, Cecum, Intussusception, Gallium-67, Adult 

INTRODUCTION 

Intussusception is rarer in adults than in children.l We experienced the gallium-67 (67Ga) scintigraphy on a patient with intussussusception caused by malignant lymphoma (ML) of the cecum. Since this finding of the location of 67Ga accumulation was thought to be rare and also useful in suggesting the presence of intussusception, we presented the case. 

CASE REPORT 

A 39-year-old male was referred to our hospital because of persistent abdominal pain. Barium enema examination revealed a large tumor in the cecum (Fig. l). Endoscopic examination also showed a Borrmann type I like tumor (Fig. 2). Biopsy was performed, but only necrotic tissue was obtained. ML was included in the differential diagnosis, and therefore 67Ga scintigraphy was performed. In spite of the cecum lesion, 67Ga accumulation was recog-nized only in the right epigastrium (Fig. 3). CT performed four days after 67Ga scintigraphy showed a large target like mass, which indicated the presence of intussusception (Fig. 4). The patient complained of no aggravation of the symptoms during these 
examinations. Except for this lesion, no abnormality was detected. An operation was performed and revealed a tumor of the cecum and ileocolic intus-susception. Histopathology showed that the tumor was ML (B cell, diffuse large cell type) (Fig. 5), and no inflammation or necrosis caused by intussuscep-tion was evident. DISCUSSION 

In adults, intussusception is rare, accounting for only 0,1% of all adult hospital admissions and 5-16% of all intussusceptions.1 Unlike in children, the diagnosis of adult intussusception is often difficult due to its usually chronic history. Ultrasonography and CT can identify intussusception by its charac-teristic target-like appearance.2,3 Adult intussuscep-tion has a demonstrable cause in over 90% of cases in contrast to child intussusception, which is idio-pathic in 90% of cases.1 In a review of I ,214 reported adult intussusception cases, 45% (546 cases) involved the colon and 55%; the small intestine. Of the colon intussusceptions, 48%; resulted from malignant tumors and 21% from benign lesions, and the most common responsible benign tumor is a lipoma of the ileocecal valve.4-6 
Primary ML of the colon and appendix is rare, but ML is the most common sarcoma of the colon, and the cecum is the site of the lesion in 85% of cases.7 The usefulness of 67Ga scintigraphy in the evaluation of ML is well known, but 67Ga accumu-lation in colon carcinoma is also reported.8 In the present case, the findings of Ba enema, CT and strong 67Ga accumulation and its location suggested the intussusception caused by ML of the cecum. The symptom of the patient was thought to be due to intussusception. However barium enema and endoscopic examination failed to show the presence of intussusception. The reason was thought to be that reduction of the intussusception was performed by retrograde air infusion during the examination procedure. 67Ga scintigraphy and CT showed the nature of the disease. 
In conclusion, a rare case of adult intussusception caused by ML of the cecum was reported. CT and 67Ga scintigraphy were useful in diagnosis. ACKNOWLEDGMENT 

The authors thank Mr. Mr. Atsuo Fujii and valuable assistance. Hiromi Saito, Mr. Keigo Tanaka, Miss Yumiko Tsuda for their 

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