1. David J. Hass, MD Assistant Clinical Professor of Medicine Yale University School of Medicine Gastroenterology Center of Connecticut, P.C.

2. Case # 4 72 year-old male Profuse diarrhea and night sweats 25 pound weight loss over six months

3. Case # 4 Slightly cachectic Physical exam otherwise unremarkable

4. Case # 4 WBC 18,000 with a slight lymphocytic predominance Normal chemistries ESR 120 Negative celiac serologies Normal IgA level, normal chromogranin A level Negative stool studies

5. Case # 4 Negative EGD Negative Colonoscopy CT scan – borderline enlarged lymphadenopathy Normal gallium scan Normal small bowel series A capsule endoscopy was performed….

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9. Case # 4 Double balloon enteroscopy performed for tissue sampling Diagnosis: Small bowel diffuse large B-cell lymphoma Patient underwent CHOP chemotherapy with a good clinical response, dying of an unrelated cause 3 yrs after his diagnosis of lymphoma.

10. Case # 4 Diffuse large B cell lymphoma of the small bowel is an uncommon neoplasm. In contrast to gastric lymphoma, small bowel B cell lymphomas do not appear to be associated with H pylori. Capsule endoscopy has proven useful for diagnosis of obscure causes of gastrointestinal illness. In this case, making the diagnosis of a mass lesion that was not found using other methods.