Our patient presented with symptoms and signs of acute appendicitis with raised inflammatory markers. Several studies have emphasised the importance of raised inflammatory markers, when a diagnostic dilemma of appendicitis arises. Hence we decided to do a diagnostic laparoscopy with an intention to perform an appendectomy.
Lymphoid hyperplasia is very common in children but is very uncommon in adults.5
The aetiology of florid lymphoid hyperplasia is hypothesised to be the result of an antigenic response,6
In our case, no specific source of infection was identified.
Rubin et al
illustrated that terminal ileal lymphoid hyperplasia can be divided into childhood (common) and adult (rare) form.7
The adult form is difficult to distinguish from low grade lymphoma, but can only be differentiated by the absence of light chain restriction.7,8
In our case we demonstrated both kappa and lambda light chains on immunohistochemical staining. Though there are a few case reports of association with other systemic diseases such as multiple intestinal polyposis,3
and malignant lymphoma,12
these associations were noted to occur only in children <10 years of age.13
The malignant potential of this condition in adults is still unclear. Our case did not show any evidence of malignancy. Larger case series are required to establish the aetiopathogenesis and malignant potential of this condition. It can be misdiagnosed as acute appendicitis or Crohn’s disease at surgery, as happened in our case.
- Florid lymphoid hyperplasia can present to surgeons as acute appendicitis.
- At operation it might look like Crohn’s disease
- Local surgical resection is curative.