Enteric Protein Loss with Hypoproteinemia in Diffuse Lymphosarcoma of the Bowel

Abstract

The case of a patient with diffuse lymphosarcoma of the large and small bowel, generalized edema, and severe hypoproteinemia has been presented. Roentgenograms of the patient''s small bowel and colon showed the typical features of diffuse infiltrative lymphosarcoma; the diagnosis was confirmed by biopsies of jejunum and rectum. Investigation of the hypoproteinemia established that it resulted from abnormal enteric loss of protein. Studies with I131 labeled albumin indicated unimpaired synthesis but very rapid turnover of albumin. Fecal excretion of intravenously administered I131 -labeled polyvinylpyrrolidone (PVP) was found to be abnormally high. Treatment with chlorambucil effected striking clinical improvement, with increase in serum proteins to normal levels and disappearance of edema. Roentgenograms, sigmoidoscopy, and biopsy examination gave evidence of marked regression of the neoplasm in the bowel. A second test with I131 -labeled PVP showed improvement. Hypoproteinemia due to gastrointestinal loss of protein has been found in association with many pathological conditions of stomach and bowel. Lymphosarcoma of the bowel apparently can be included in the list of disorders in which "protein-losing gastroenteropathy" may occur.