Primary Diffuse Large B-cell Lymphoma of the Colon Presenting as Idiopathic Thrombocytopenia: A Case Report.

Introduction: Primary lymphoma of the colon and rectum is an uncommon form of cancer comprising less than 0.5% of all colorectal tumors combined. Typically, extra nodal lymphomas manifest in the gastrointestinal tract, with non - Hodgkin lymphoma being the most frequent subtype and the stomach being the most common location. Case presentation: 70 year old female with medical history of osteoarthritis and osteoporosis was evaluated for bilateral leg rash and thrombocytopenia. Eventual work up revealed cecal mass but inconclusive findings on colonoscopy. She underwent hemicolectomy due to persistent thrombocytopenia with histopathology positive for primary Diffuse Large B-cell Lymphoma (DLBCL). She underwent chemotherapy with complete resolution of her mass and lymphadenopathy. Conclusion: We are presenting a rare case of Non - Hodgkin lymphoma in the colon. This disease can show up with unclear symptoms, so it's important to use different types of imaging and pathology tests to identify the specific type of lymphoma. The main treatment for this type of cancer involves using chemotherapy and radiation therapy.

Collision tumor of primary malignant lymphoma and adenocarcinoma in the colon diagnosed by molecular pathology: A case report and literature review.

BACKGROUND: Collision tumors of primary malignant lymphoma and adenocarcinoma in the colon are rare. Primary diffuse large B-cell lymphoma (DLBCL)-adenocarcinoma collision tumors are especially rare. CASE SUMMARY: A 74-year-old woman presented with abdominal pain of 1 mo duration. Biopsy under colonoscopy revealed adenocarcinoma of the ascending colon. Subsequently, the patient underwent laparoscopic radical resection of right colon cancer with lymph node dissection. A collision tumor was found incidentally through postoperative pathological sampling. Genetic analysis showed a collision tumor of DLBCL with germinal center B-cell subtype and TP53 mutation, and adenocarcinoma arising in a tubulovillous adenoma in the colon, with BRAF mutation and mutL homolog 1 promoter methylation. The patient died 3 mo after surgery. To our knowledge, this is the 23rd reported case of collision tumor of colorectal adenocarcinoma and lymphoma. The mean age of the 23 patients was 73 years. The most common site was the cecum. There were 15 cases with follow-up data including 11 living and four dead with a 3-year overall survival rate of 71.5%. CONCLUSION: Based on pathological and genetic analysis, surgery combined with chemotherapy or chemoradiotherapy may have good therapeutic effects for collision tumor.

Unusual presentation of aggressive high-grade B-cell lymphoma of colonic origin: A case report and review of the literature.

Colonic lymphoma is a rare disease. The presented case is unique, being manifested with abrupt onset, including circulatory shock and lactic acidosis as the initial presentation.

Marginal zone lymphoma of the colon: case series from a single center and SEER data review.

Colon extranodal marginal zone lymphoma (EMZL) is poorly characterized in the literature. We performed a retrospective review of patients with colon EMZL at our institution and from the Surveillance Epidemiology and End Results (SEER) database. Eight patients were identified in our institution with majority (88%) presenting with stage-I disease. Initial management included active surveillance, polypectomy followed by surveillance, and surgical resection followed by chemotherapy. One patient with concurrent prostate carcinoma received radiation to the rectum. Initial therapy led to complete remission in five out of six treated patients with four of them maintaining remission at 88 months. SEER database identified 361 patients with stage-I colon EMZL. Overall survival for this cohort was 73.9% at 10 years with no significant difference in outcomes between treatment groups. Our single institution experience and the SEER data analysis emphasize indolent nature of colon EMZL and need for non-aggressive therapeutic approaches.

Primary diffuse large B-cell lymphoma of the sigmoid colon.

INTRODUCTION: Extranodal lymphomas are commonly encountered in the gastrointestinal tract but lymphomas of colon and rectum are rare. Non-Hodgkin lymphoma is the most common type of colonic lymphoma and represents less than 0.5% of colorectal neoplasms. Chemotherapeutical agents are gateway to disease remission and sometimes cure in most patients but surgery may be necessary in emergent situations. CASE PRESENTATION: A 77-year-old male patient presented with abdominal discomfort, constipation, and obstructive defecation symptoms. Radiological imaging revealed a mass in the sigmoid colon extending towards the rectum. Colonoscopy was performed and biopsy of a nearly 10 cm ulcerovegetative lesion was obtained. Histological examination following biopsy revealed it to be a diffuse large B-cell lymphoma of the sigmoid colon. There was no indication for surgery and the patient was referred to medical oncology clinic for chemotherapy treatment. DISCUSSION: Non-Hodgkin lymphoma is a lymphoproliferative disorder with the diffuse large B cell lymphoma (DLBCL) being the most common subtype. The DLBCL subtype is rarely observed in the colon and rectum. Chromosomal abnormalities are involved in the pathophysiology and gene rearrangements lead to adjustments in lymphocyte function and differentiation. CONCLUSION: In this case report, we present a rare presentation of a Non-Hodgkin lymphoma presenting in the sigmoid colon. The disease can present with nonspecific symptoms and various imaging modalities along with histopathological evaluation is necessary for the correct subtyping of lymphoma. Chemoradiotherapy is key for treatment, and surgery is usually reserved for cases of obstruction, perforation, or bleeding.

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.

[Colonic lymphoma revealed by ileocecal intussusception in adults: about a case]. / Lymphome colique révélé par invagination iléo-caecale chez l'adulte: à propos d'un cas.

Intussusception is a very common condition in pediatrics, while in adults it is rare and accounts for only 10% of intussusceptions and 4% of intestinal occlusions. Colonic lymphoma revealed by intussusception is a very rare disease. We report the case of a 21-year old woman admitted with intestinal subocclusion to the Emergency Department at the Military Hospital Moulay Ismail, Meknes Morocco. Abdominal CT scan showed "sausage-shaped" mass as well as its organic cause in the colon. Surgical resection was the treatment of choice, followed by anatomo-pathological examination of the surgical specimen which showed diffuse large B-cell lymphoma. After surgery, chemotherapy was indicated in order to improve the prognosis and to avoid a possible relapse.

Angina mesentérica en un paciente con linfoma de colon y adenocarcinoma prostático / Mesenteric angina in a patient with colonic lymphoma and prostatic adenocarcinoma

Resumen La angina mesentérica es un síndrome causado por la inadecuada perfusión sanguínea por parte de los vasos mesentéricos, que resulta en isquemia y a la larga en gangrena de la pared intestinal. Aunque relativamente poco frecuente, es un padecimiento potencialmente mortal. Reportamos un caso de isquemia mesentérica que inició con plenitud, dolor posprandial temprano, distensión abdominal y pérdida de peso en un paciente previamente diagnosticado y tratado de linfoma de colon y adenocarcinoma prostático.

Abstract Mesenteric angina is a syndrome caused by inadequate perfusion from the mesenteric vessels, resulting in ischemia and eventually gut necrosis. Although relatively rare, it is a potential deadly condition. We report a case of mesenteric ischemia which began with bloating, postprandial pain and weight loss on a patient previously diagnosed and treated from colonic lymphoma and prostatic adenocarcinoma.

Persistent Afebrile Abdominal Pain: An Unusual Case of Segmental Colitis in an Immunocompromised Host.

In this report we describe a case of a 66-year-old woman who presented with right upper quadrant abdominal pain and bloody diarrhea. A workup revealed immunodeficiency, an immunologic profile with low complement levels resembling systemic lupus erythematosus, and a circumferential colonic wall lesion located in the ascending colon. After endoscopy and biopsy, the mass lesion was attributed to "double hit" diffuse large B-cell lymphoma, categorized as high grade large B-cell non-Hodgkin lymphoma according to the most recent revised 2016 World Health Organisation classification and considered to be a rare and highly aggressive tumor. The diagnosis of colonic lymphoma can be challenging due to a diversity of clinical presentation and requires a high index of suspicion. As the literature of such documented reports is limited, this case suggests further investigations. ABBREVIATIONS: GI: gastrointestinal tract, DLBCL: diffuse large B cell lymphoma, DH: double hit lymphoma, SLE: systemic lupus erythematosus, ANA: antinuclear antibodies, anti-ssDNA: anti-single-stranded DNA, BCL: B-cell lymphoma protein, MUM-1/IRF4: multiple myeloma oncogene 1/interferon regulatory factor 4, HGBL: high grade B-cell lymphoma, anti-dsDNA: anti-double-stranded DNA.

Concomitant non-Hodgkin's lymphoma in colon and liver: report of a rare case and review of literature.

A 58-year-old male patient was admitted with right upper abdominal pain. Initial hematologic evaluation revealed mildly elevated serum carcinoembryonic antigen and carbohydrate antigen (CA) 19-9 tests, while an abdominal CT-scan showed a circumferential mass along the distal ascending colon and the right flexure of colon, simultaneously a liver lesion in segment 8 is considered metastases from colorectal. colonoscopic examination revealed a circumferential growth tumor in the right flexure of colon and the colonoscopy can not reach the proximal of the tumor. We performed a right hemihepatoectomy and a right hemicolectomy associated with loco-regional lymphadenectomy. Histological examination showed diffuse large B-cell lymphomas in resected right colon as well as liver tumors. The patient received six courses of chemotherapy with CHOP-based regimens. At 14-month follow-up before this report, the patient is still alive and free of disease.

Primary colonic lymphoma: An incidental finding in a patient with a gallstone attack.

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound (US) and total body computed tomography (CT) exams that allowed us to make the correct final diagnosis. A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant, spreaded to the right shoulder blade. Patient had nausea and mild fever and Murphy's maneuver was positive. At physical examination a large bulky mass was found in the right flank. Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspondence of the palpable mass, an extended concentric thickening of the colic wall. CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum. In addition, revealed signs of microperforation of the colic wall. Numerous large lymphadenopathies were found in the abdominal, pelvic and thoracic cavity and there was a condition of splenomegaly, with some ischemic outcomes in the context of the spleen. No metastasis in the parenchimatous organs were found. These imaging findings suggest us the diagnosis of lymphoma. Patient underwent to surgery, and right hemicolectomy and cholecystectomy was performed. Histological examination confirmed our diagnosis, revealing a diffuse large B-cell lymphoma. The patient underwent to Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone chemotherapy showing only a partial regression of the lymphadenopathies, being in advanced stage at the time of diagnosis.

The recognition and classification of lymphoproliferative disorders of the gut.

Gastrointestinal lymphomas can be difficult to diagnose, particularly in small samples, when early in development, or when of unusual types. In this review, we describe lymphoid proliferations in the gastrointestinal tract in a location-based manner, including, mouth, esophagus, stomach, small intestine, and large bowel. For the purpose of differential diagnosis, benign mimics of lymphoma are also described. Lymphoma types that are specifically addressed include plasmablastic, extranodal natural killer/T-cell-nasal type, extranodal marginal zone lymphoma (eg, mucosa-associated lymphoid tissue lymphoma), diffuse large B cell, primary follicular of small intestine, enteropathy-associated T cell, and Burkitt and mantle cell. Immunohistochemical markers useful in the diagnostic approach are elaborated in detail.

Synchronous adenocarcinoma and extranodal natural killer/T-cell lymphoma of the colon: a case report and literature review.

Extranodal natural killer/T-cell lymphoma (ENKTL) is a distinct subtype of non-Hodgkin's lymphoma and is rare in the colon. Synchronous adenocarcinoma and ENKTL of the colon has not been reported in the literature. In the present study, we report a 63-year-old male who suffered from intermittent bloody stools for 2 mo. He did not have fever, body weight loss or night sweat. Endoscopic and imaging studies revealed a 4.5-cm ulcerative mass in the ascending colon and a 3.0-cm polypoid, easy bleeding mass in the sigmoid colon, respectively. Thought to have double carcinoma of the colon, he received simultaneous right hemicolectomy and sigmoidectomy. The pathological diagnosis was a synchronous ENKTL (ascending colon) and adenocarcinoma (sigmoid colon). The literature on synchronous adenocarcinoma and malignant lymphoma of the colon was also reviewed.

Diffuse large B cell lymphoma of the rectosigmoid junction: case report and literature review.

Primary colorectal lymphoma (PCL) is a rare condition that accounts for asmall percentage of all gastrointestinal (GI) malignancies. There are severalreports in the literature regarding the most common features of PCL. However,primary lymphoma in the rectosigmoid junction has been rarely reported. Ourcase was a 67-year-old male who presented with non-specific symptoms ofbowel obstruction which, upon further workup, was diagnosed as a rare case ofPCL located in the rectosigmoid junction.

Lymphoma presenting as a necrotic colonic mass.

Primary colonic lymphomas represent a rare minority among the colonic neoplasms. Their correct pre-operative identification is crucial for the design of treatment. We herein describe a case of a colonic lymphoma presenting as a necrotic colonic mass and we discuss the current evidence about the presentation, diagnosis and treatment of lymphomas isolated to the colon.

Linfoma anaplásico de grandes células T com envolvimento do cólon: relato de caso / Anaplastic large T-cell lymphoma with involvement of the colon: case report

JUSTIFICATIVA E OBJETIVOS: Linfoma anaplásico de grandes células é um tipo raro de linfoma não-Hodgkin (LNH) originado de linfócitos T maduros. O diagnóstico é feito a partir de quadro morfológico típico e de um imunofenótipo de células T positivo para CD30. As lesões gastrintestinais são os tipos mais comum de linfomas extranodais primários, representando cerca de 5% a 10% de todos os LNH, sendo mais comum no fenótipo de células B. O objetivo deste relato foi descrever um caso com envolvimento primário do cólon, evoluindo rapidamente para a fase terminal, com falência múltipla de órgãos e sistemas. RELATO DO CASO: Paciente do sexo masculino, 50 anos, admitido no serviço de Clínica Médica do Hospital Santa Casa do Rio Grande (ACSCRG) com história de dor abdominal inespecífica há dois meses. Havia realizado endoscopia digestiva alta e recebeu tratamento, ao final do qual desenvolveu lesões cutâneas eritematosas difusas, que motivaram sua admissão para investigação.Febril, com abdômen levemente distendido e fígado palpável. Na videocolonoscopia identificou-se placas arredondadas de mucosa escurecida com 4 a 6 mm em meio à mucosa normal, estendendo-se até o íleo terminal. CONCLUSÃO: O linfoma anaplásico de grandes células é raro e infrequente em descrições e revisões. Tipo raro de LNH apresenta-se com comportamento agressivo, em estágio avançado e frequentemente com localização extranodal. A localização gástrica é a mais encontrada, seguida pelo intestino delgado.

BACKGROUND AND OBJECTIVES: Anaplastic large cell lymphoma is a rare type of non-Hodgkin lymphoma originated from mature T lymphocytes. The diagnosis is made from the recognition of typical morphological features and a CD30-positive T-cell immunophenotype. The gastrointestinal lesions are the most common type of primary extranodal lymphomas, accounting for about 5% to 10% of all NHLs, being more common in B-cell phenotype. The purpose of this report describes a case with primary involvement of the colon, rapidly progressing to the terminal phase, with the multiple organ dysfunction syndrome.CASE REPORT: A 50-year-old man admitted to the Internal Medicine ward at the, Hospital Santa Casa do Rio Grande (ACSCRG) with a history of nonspecific abdominal pain for two months. Endoscopy had been undertaken and he received treatment, at the end of which he developed diffuse erythematous skin lesions, which motivated admission for investigation. Investigation,feverish, with slightly distended abdomen and palpable liver. Through colonoscopy it was identified rounded plaques of darkened mucosal with 4 to 6 mm among the of normal mucosa, extending to the terminal ileum. CONCLUSION: Anaplastic large cell lymphoma is rare and infrequent in descriptions and reviews. Rare type of non-Hodgkin lymphoma (NHL), this disease presents itself with an aggressive course, advanced stage, and often extranodal location. The gastric location is the most common, followed by the small intestine.

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.

A Case of Primary Colonic Lymphoma with Peritoneal Carcinomatosis and Pleural Effusion / 대한소화기내시경학회지

Primary gastrointestinal lymphomas are quite rare with the stomach and small bowel being the most frequent site. Colon involvement is observed in only 10~20% of all gastrointestinal lymphomas. A colonic lymphoma presents with non-specific abdominal pain, weight loss, a change in bowel habits, bleeding, intestinal obstruction, intussusception and a palpable mass. A colonic lymphoma can be indicated using a barium enema, abdominal CT and colonoscopy. The correct diagnosis is obtained by a colonoscopic biopsy. We report a case of primary colonic non-Hodgkin's lymphoma with peritoneal carcinomatosis and a right pleural effusion.

Primary Cecal Lymphoma

PURPOSE: Primary colonic lymphomas are very rare disorders and the most common location of a colonic lymphoma is the cecum. However, the prognosis for patients with a primary cecal lymphoma is not well understood clear. This study was undertaken to assess the prognosis for patients with a primary cecal lymphoma. METHODS: A retrospective analysis of our patients, who were categorized into two groups, cecal lymphoma (10 cases) and non-cecal lymphoma (10 cases), was performed from January 1985 to December 2001. The prognostic factors were analyzed. RESULTS: The most common presenting symptoms and signs of cecal lymphomas were abdominal pain (80.0%), nausea/ vomiting (80.0%), and abdominal mass (40.0%). The preoperative biopsy- proven diagnostic rate of cecal lymphoma was 10.0%. The mean size of cecal lymphomas was significantly smaller than that of non-cecal lymphomas (6.2 cm vs. 10.0 cm). Histologically, 9 (90.0%) of the primary cecal lymphomas were classified as intermediate-grade lymphoas, and 1 (10.0%) as a high-grade lymphoma. three (30.0%) of the cecal lymphomas were Stage IE, 5 (50.0%) were Stage IIE1, and 2 (20.0%) were Stage IVE. Tumor resection and chemotherapy was used for 8 (80.0%) of the cecal lymphomas. Two regimens of chemotherapy were used: CHEP-Bleo (cyclophosphamide, doxorubicin, and epirubicin, prednisone, and bleomycin) and COP-BLAM (cyclophosphamide, vincristine, prednisone, bleomycin, doxorubicin, procarbazine). The median survival time for patients with a cecal lymphoma was 56 months, but that survival time was not significantly different from the survival time for patients with non-cecal lymphoma. CONCLUSIONS: The prognosis for patients with a primary cecal lymphoma appears to be similar to that for patients with a non-cecal lymphoma. However, the number cases in our study was very small, the more cases are needed to establish a general prognosis for patients with a primary cecal lymphoma.