**6.2 Clinical presentation**

Many of the symptoms of intestinal lymphoma are very similar to those caused by inflammatory bowel disease. The most commonly presenting symptom is bloody diarrhoea occurring in almost three quarters of cases (Holubar et al., 2010, Wong and Eu, 2006). Other common symptoms include abdominal pain, weight loss and sweats. Presentation with bowel obstruction and perforation occurs less frequently (Holubar et al., 2010, Bourikas et al., 2008). Diagnosis of lymphoma is frequently made following laparotomy. Endoscopic appearances can be diverse, manifesting as ulceration, polyps or masses.

Duration of IBD before development of lymphoma appears to be very variable between individual cases. Shepherd et al reported 10 cases of colorectal lymphoma complicating inflammatory bowel disease (6 patients with UC and 4 with CD) (Shepherd et al., 1989). The duration of inflammatory bowel disease varied from 30 months to 20 years in these cases. In the CESAME study, there was between 1 to 16 years of exposure to thiopurines before lymphoma diagnosis (Beaugerie et al., 2009a).

More unusual presentations of lymphoma include jaundice due to a nodal mass at the porta hepatis in a patient with Crohn's disease (Parasher et al., 1999), spontaneous tumour lysis syndrome in a Crohn's patient with a plasmacytoma (Froilan Torres et al., 2009), nephrotic syndrome in a patient with Hodgkin's lymphoma and UC (Basic-Jukic et al., 2002), and jaundice due to vanishing bile duct syndrome in a patient with Hodgkin's lymphoma and IBD (DeBenedet et al., 2008).
