Primary extraperitoneal rectum lymphoma in AIDS patient / Linfoma primário de reto extraperitoneal em paciente SIDA

ABSTRACT Introduction The gastrointestinal lymphoma can be classified in primary or secondary, and this is important regarding diagnosis and subsequent treatment. Primary gastrointestinal lymphoma of the rectum is rare and therefore lacks data in medical literature. Its incidence has been increasing and that fact may be related to a higher incidence in immunosuppressive therapy and immunosuppressive diseases (such as AIDS). Metodology 19 articles have been reviewed, searched online on the Scielo and PubMed databases. The goal was to increase data available regarding this pathology and improve its therapy. Discussion Primary GI lymphoma of the rectum presents as hematochezia, rectal pain, change in bowel habits. PET/CT is the first choice exam to pursue investigation; however abdominal CT and MRI reveal sufficient information and are much more available in daily practice. Plasmablastyc lymphoma is an aggressive subtype and is usually associated with AIDS patients. There are no available treatment protocols for this specific type of lymphoma and colonic lymphoma's therapy is usually used for this patient (such as ECHOP and CHOP). Conclusion As rare as this pathology is, this article aims to improve the available data and provide useful information regarding diagnosis and therapy.

RESUMO Introdução O linfoma do TGI pode ser dividido entre primário e secundário, com importância diagnóstica e terapêutica. O linfoma primário de reto é patologia rara, pouco relatada em literatura médica. Sua incidência tem aumentado e possivelmente esse fenômeno esteja associado ao aumento no numero de pacientes com imunossupressão (seja por SIDA ou drogas imunossupressoras). Metodologia Foram revisados 19 artigos nas bases de dados Scielo e PubMed, com o objetivo de aumentar o número de relatos dessa patologia e consequentemente expandir o conhecimento disponível, visando melhorar a terapêutica e, principalmente, o diagnóstico desse tipo de linfoma. Discussão Quando o linfoma tem seu sítio primário no reto, as principais manifestações são sangramento, dor retal, tenesmo e mudança nos hábitos intestinais (diarreia ou constipação). O exame de investigação de escolha é o PET/CT, porém a TC e RNM fornecem as informações necessárias e são mais disponíveis na prática clínica. O linfoma plasmablástico é um subtipo bastante agressivo e associado aos pacientes com SIDA. Não existem ainda protocolos definidos para o tratamento do linfoma primário de reto, sendo optado por seguir a mesma terapêutica dos linfomas de cólon com esquemas EPOCH e CHOP. Conclusão Por se tratar de patologia rara e pouco descrita na literatura, espera-se que este relato contribua na formação de protocolos de tratamento específicos.

Linfoma primario del intestino delgado: reporte de un caso y revisión de la literatura / Primary Lymphoma in the Small Intestine: A Case Report and Literature Review

El tracto gastrointestinal es el sitio más frecuente de presentación del linfoma no Hodgkin (LNH) extraganglionar. Sin embargo, los linfomas primarios del tracto gastrointestinal son tumores raros y es mucho más frecuente la afectación de este tracto de manera secundaria en el curso de la enfermedad. Representan del 1% al 4% de los tumores malignos del tracto gastrointestinal, aunque tienen un curso, manejo y pronóstico muy diferente de los adenocarcinomas, por lo que es importante conocerlos y tenerlos en mente como un diagnóstico diferencial posible en el ejercicio clínico diario. Afectan más a los adultos jóvenes, con una mayor frecuencia en hombres (1). Reportamos el caso de una mujer de 47 años de edad con linfoma primario del intestino delgado, diagnosticado luego de múltiples consultas por síntomas abdominales y revisamos la literatura al respecto

The gastrointestinal tract is the most frequent site of non-Hodgkin’s lymphoma (NH) outside of the lymph nodes themselves. This tract is much more frequently compromised by tumors secondary to primary disease elsewhere in the body than by primary lymphomas of the gastrointestinal tract itself which are rare. They account for only one to four percent of malignant tumors of the gastrointestinal tract. Their development and prognoses are quite different from those of adenocarcinomas, hence their management must differ as well. It is important to understand them and keep them in mind in differential diagnosis in daily clinical practice. Young adults are most frequently affected, and men are more frequently affected than are women. We review the literature and report the case of a 47 year old woman with primary small bowel lymphoma that was diagnosed after several consultations due to abdominal symptoms

Linfoma primário de cólon: relato de caso / Primary colorectal lymphoma: case report

O linfoma colorretal primário é uma doença rara (0.2 a 0.6 por cento de todas as neoplasias colônicas), apresentando pior prognóstico quando comparado com o linfoma gástrico primário ou com o adenocarcinoma do cólon. É uma doença com sintomatologia inespecífica, o que dificulta o diagnóstico precoce. O objetivo deste relato é mostrar um caso de linfoma primário do cólon, revisar critérios diagnósticos e tratamento.

The primary colorectal lymphoma is a rare disease (0.2 to 0.6 percent of all colonic neoplasias), that has a worse prognosis than primary gastric lymphoma or colon adenocarcinoma. The poor signals makes the early diagnosis difficult. The objectives of this report is to describe a case of primary colon lymphoma, revise diagnosis criteria and treatment.

Incidencia de linfoma gastrointestinal en el hospital militar Dr. Carlos Arvelo en el lapso 2003-2008 un período de 5 años

Los Linfomas No Hodgkin del tracto gastrointestinal son los linfomas extranodales más comunes, representando entre el 30 y 70% de esta última patología constituyendo un grupo heterogéneo de tumores con diferentes características clínicas y patológicas. El estómago está lesionado de manera predominante siendo los linfomas tipo MALT los tumores de bajo grado más frecuentes en el sistema gastrointestinal, contando con 40% de todos los linfomas gástricos primarios, manteniéndose localizados por períodos prolongados sin tratamiento. Objetivos: evaluar la epidemiología de los linfomas gastrointestinales en nuestro centro. Pacientes y métodos: Análisis retrospectivo de las historias de pacientes con diagnóstico de Linfoma Gastrointestinal. Resultados: Se presentan datos clínicos e histopatológicos de 20 pacientes con diagnóstico de Linfoma Gastrointestinal tratados en el Hospital Militar "Dr. Carlos Arvelo", Caracas, Venezuela, desde 2003 a 2008. 15 hombres, 5 mujeres, con edades comprendidas entre 23 y 64 años. De ellos, 14 (70 %) se presentaron con enfermedad limitada (estadio I-II) mientras que 6 (30%) tuvieron lesión de varios órganos (hígado, páncreas, bazo, duodeno) o más de un órgano gastrointestinal, siendo clasificado como estadio IV. 11 pacientes tuvieron linfoma gástrico, 2 de páncreas, 1 hepático esplénico y de columna lumbar, 1 intestino delgado, 1 en bazo, 4 de colon, y en 5 pacientes se observaron multiples localizaciones en el sistema gastrointestinal. Dolor abdominal, hemorragia digestiva, pérdida de peso fueron los síntomas más frecuentes de presentación. El estómago fue el órgano mas frecuentemente lesionado.

Non-Hodgkin´s lymphomas (NHL) of the gastrointestinal (GI) tract are the most common extra nodal lymphomas. They represent between 30% to 70% of all extra nodal lymphomas and constitute a heterogeneous group of tumors with different clinical and pathological features. The stomach is predominantly involved. MALT type lymphomas are the most frequent low grade non-Hodgkin´s lymphomas encountered in the GI tract. They account for 40% of all primary gastric lymphomas and remain, in the majority of cases, localized for a prolonged period of time without therapy. Aim: To evaluate the epidemiology of gastrointestinal lymphomas in our Hospital. Patients and Methods: Retrospective analysis of patientÊs recorders performed at the Hospital Militar "Dr. Carlos Arvelo", Caracas, that had the diagnosis of gastrointestinal lymphoma. Results Clinical and histopathologjcal data from 20 patients presenting with GI-NHL treated from 2003 until 2008, were reviewed. 15 men, 5 women with an age range between 23 and 64 years old. Of these, 14 (70%) presented with limited disease (stage I and II), while 6 patients were found to have disease involvement of other abdominal organs (i.e., liver, pancreas, spleen, duodenum) or more than one gastrointestinal site and were therefore classified as stage IV. 11 patients presented with lymphoma in the stomach, 2 pancreatic, 1 in liver, spleen and lumbar vertebrae, 1 in the small intestine and 4 in the large bowel, while in 5 cases multiple localizations of the gastrointestinal tract were documented. Abdominal pain, gastrointestinal bleeding, weighs loose were the main presenting symptom.