Multicentric colonic lymphoma complicating ulcerative colitis

Primary colorectal lymphoma

PURPOSE

The purpose of this study was to review the clinical presentation and characteristics of primary colorectal lymphoma, analyze the prognostic factors, and assess the results of treatment with adjuvant chemotherapy.

METHODS

We identified 37 cases at our institution between 1980 and 1996. They comprised 0.48 percent of all cases of colon malignancies (37/7,658) during this period. The following clinical information was obtained: age, gender, signs and symptoms, tumor site, tumor size, histology grade, pathology, and adjuvant chemotherapy.

RESULTS

The most common presenting signs and symptoms were abdominal pain (62 percent), abdominal mass (54 percent), and weight loss (43 percent). The most frequent site of involvement was the cecum (45 percent). Histologically, 29 (78 percent) were classified as high-grade, and 8 (22 percent) as intermediate-grade-to-low-grade lymphoma. Nine (24.3 percent) of the cases were Stage EI, 23 (62.2 percent) were Stage EII, and 5 (13.5 percent) were Stage EIV. Twenty-one (57 percent) cases received adjuvant chemotherapy. The five-year survival rate was 33 percent for all patients and 39 percent for patients treated with combination chemotherapy. Overall median survival time was 24 months and 36 months for those with adjuvant chemotherapy. Only histology grade, among the factors examined, was a significant prognostic factor for survival. The mean survival time of the patients with Stage II disease who received chemotherapy was 117.4 months, and it was 47.9 months for the patients with Stage II disease who did not received chemotherapy.

CONCLUSIONS

In our retrospective study high-grade lymphoma was the only significant adverse prognostic factor for survival. Receiving adjuvant chemotherapy significantly improved survival in patients with Stage II disease. Patients with diffuse large-cell type had better survival than patients with small noncleaved-cell type in Stage II high-grade lymphoma.

Lymphoma at uncommon sites

Lymphoma can often present in unusual situations. This article provides a comprehensive review of the literature in which both non-Hodgkin's lymphoma and Hodgkin's disease are discussed.

Diffuse colonic mantle cell lymphoma in a patient with presumed ulcerative colitis: detection of a precursor monoclonal lymphoid population using polymerase chain reaction and immunohistochemistry

Primary lymphoma of the colon, a rare and typically late complication of ulcerative colitis, exhibits high-grade morphology and behavior when it occurs. Recently, several reports of colonic lymphoma masquerading as ulcerative colitis have been described. These previous reports described inflammatory mucosal changes typical of ulcerative colitis as being present in superficial biopsies, leading to the initial diagnosis of ulcerative colitis; however, further workup resulted in a diagnosis of primary colonic lymphoma within several months in these cases, and all symptoms and mucosal changes resolved after treatment of the lymphoma. Herein we report a case of mantle cell lymphoma arising in the colon and rectum in a 71-year-old woman with a 4-year history of ulcerative colitis. Immunoglobulin heavy-chain gene rearrangements were detected using the polymerase chain reaction procedure in fixed tissue in the lymphoma as well as in a prior resection specimen that histologically appeared to show only changes of severe ulcerative colitis. This finding suggests that an indolent lymphoid proliferation may have been the underlying disease in this patient and raises questions about the role of colonic lymphoma in causing mucosal injury.

CD30-positive T cell lymphoma of the intestine, complicating ulcerative colitis

Large cell lymphoma with massive necrosis and a phagocytic reaction (malignant histiocytosis-type lymphoma) occurred multifocally in the small and large intestine of a 52 year old male, who had suffered from ulcerative colitis of a pancolonic type for 2 years. After total colectomy and partial jejunectomy, the tumor recurred repeatedly during the subsequent 3-year period. He died of massive intestinal hemorrhage with mild regional lymph nodal involvement. Surface marker studies disclosed CD4/CD8-double negative and CD30+ T cell features. CD3 was weakly expressed. Epstein-Barr virus infection was not identified. The relationship of this neoplasm with 'enteropathy-associated T cell lymphoma' and intestinal Ki-1 lymphoma is discussed.

Primary malignant lymphoma of the intestine

Primary intestinal lymphoma is uncommon but not rare. Its pathology and potential therapy are complex. Its epidemiology has changed radically over the past century, reflecting a sharp surge in the incidence of intestinal lymphoma, particularly that associated with immunosuppression. Recent advances in diagnosis, a new approach to pathologic classification by immunotyping, and a new staging system have influenced therapy. New multimodal therapeutic protocols have improved the prognosis of this once deadly disease.

Inflammatory bowel disease. Part II: Clinical and therapeutic aspects

Once regarded as medical curiosities, ulcerative colitis and Crohn's disease have achieved a remarkable change in status recently and today are among the more compelling of all human illnesses. The cause(s) of inflammatory bowel disease (IBD) are not known. Genetic, environmental, microbial, and immunologic factors are involved, but the precise mechanisms are obscure. The incidence of ulcerative colitis is relatively stable, while Crohn's disease continues to increase in frequency. In 10% to 15% of patients, it is hard to differentiate between ulcerative colitis and Crohn's colitis, however, problems with diagnosis usually resolve with time and repeated examinations. In part I of his two-part monograph on IBD, Dr. Kirsner addressed the nature and pathogenesis of the disease. Increased study of ulcerative colitis and Crohn's disease in recent years has generated new knowledge regarding their etiology. Part I focused on microbial, immunologic, and genetic mechanisms of, and the inflammatory process involved in the disease. In this part, Dr. Kirsner deals with the clinical features, course, and management of IBD, based on the author's 55 years of experience with these problems and supplemented by critical examination of the recent (1988-1990) literature. Particular attention is directed to the symptoms and physical findings of ulcerative colitis and Crohn's disease. The laboratory, radiologic, endoscopic, and pathologic features, and the many systemic complications. IBDs are mimicked by several enterocolonic infections and other conditions making differential diagnosis necessary. Inflammatory bowel disease in children and the elderly conforms to conventional clinical patterns modified by the health circumstances of the respective age groups. Because the cause of IBD has not been established, current medical therapy is facilitative and supportive rather than curative. The principles of medical treatment are approximately the same for ulcerative colitis and Crohn's disease. Treatment emphasizes a program rather than a drug and also considers the individuality of the therapeutic response. A clearer understanding of dietary and nutritional needs, including hyperalimentation and electrolyte and fluid balance, aids treatment. Antidiarrheal and antispasmodal preparation and sedatives are prescribed for symptom relief. The bowel inflammation is controlled with sulfasalazine or the newer 5-amino-salicylic acid (5-ASA) compounds, antibacterial drugs for complications of Crohn's disease and IBD, adrenocortical steroids, and the immunosuppressive compounds 6-mercaptopurine (6MP), azathioprine, and cyclosporine, as determined in each patient. The surgical procedures available for treatment of ulcerative colitis include total proctocolectomy and ileostomy or ileoanal anastomosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Malignant lymphoma in ulcerative colitis. Report of a case

The authors present the case of a 40-year-old woman with primary malignant lymphoma complicating chronic ulcerative colitis. Twenty-one cases reported in the literature are reviewed and the various available data analyzed. Variations in the distribution of lymphoma in both the normal and colitic bowel supports a relationship between both conditions. Any lymphocytic infiltrate seen in biopsies obtained from ulcerative colitis should be assessed to exclude associated lymphoma. The prognosis is poor.

Primary malignant lymphoma of the large intestine complicating chronic inflammatory bowel disease

Ten cases of malignant lymphoma of the colon and rectum complicating chronic inflammatory bowel disease are presented. Seven patients had chronic ulcerative colitis with a history varying from 6 to 20 years. There was extensive colitis in six of these patients and left-sided colitis in one. All seven lymphomas showed the pathological and immunohistological features of primary B-cell tumours of the gastrointestinal tract with a predominance of high-grade tumours. Three patients had Crohn's disease of the large intestine complicated by malignant lymphoma of the sigmoid colon or rectum. The history of Crohn's disease varied from 30 months to 20 years and in each case there was fissuring and fistulae. There was extensive anal involvement in two cases. Histologically the three lymphomas were heterogeneous: one was of 'granulomatous' T-cell type and the other two were markedly polymorphic and of equivocal phenotype. They were also characterized by numerous multinucleate tumour giant cells. Primary colorectal malignant lymphoma should be regarded as a rare, but significant, complication of ulcerative colitis. Immunosuppression may be an additional factor in the genesis of intestinal lymphoma in Crohn's disease. The prognosis appears to be dependent on factors already known to be of prognostic significance in primary gut lymphomas: a predominance of high-grade tumours suggests that the outlook is generally worse than that for idiopathic primary large intestinal lymphoma.

Colonic lymphoma in the transplant patient

A 64-year-old male renal transplant recipient developed rectal bleeding caused by a primary lymphoma of the colon, an unusual site for initial disease involvement. Renal transplant recipients may be at increased risk for the development of primary colonic lymphoma, a diagnosis that should be considered in transplant patients who develop abdominal pain, rectal bleeding, or intestinal perforation. The unique clinical features and special management considerations of colonic lymphoma in the renal transplant recipient are discussed.

Argyrophilic cell hyperplasia and an atypical carcinoid tumor in chronic ulcerative colitis

An unusual case of chronic ulcerative colitis, is presented in which an atypical carcinoid tumor was seen. Many areas of the mucosa showed glandular changes of chronic injury and dysplasia, and in these areas, argyrophilic cell hyperplasia was identified. Data is presented describing the evolution of argyrophilic cell hyperplasia as a reaction to injury, the evolution of carcinoid tumors in argyrophilic cell hyperplasia, and the relationship of the proliferating argyrophilic cells to the proliferating glandular cells in ulcerative colitis.

Rectal malignant lymphoma in chronic ulcerative colitis

Carcinoma of the colon as a complication of ulcerative colitis is relatively common, whereas malignant lymphoma is apparently rare; there are approximately 20 recorded cases. We report a case of follicular lymphoma of the rectum in a 73 year old woman with a 21 year history of ulcerative colitis. In view of the possible immune basis of ulcerative colitis, it is important to report and accurately classify cases of lymphoma arising in association with it.

Lymphoma of the colon: the spectrum of radiologic changes

Primary lymphoma of the colon is rare and comprises less than 1% of large bowel malignancies. Secondary colonic involvement in patients with advanced lymphoma is not uncommon and is frequently undetected. The radiographic findings of 34 patients with colonic lymphoma were reviewed. Thirteen patients had primary tumors, while the remaining 21 had colonic involvement secondary to systemic disease. The radiologic features were classified as mucosal nodularity, endo-exoenteric mass, intraluminal mass, mural infiltration, and mesenteric invasion. One patient with diffuse mucosal nodularity developed acute colonic dilatation, while two other patients had pneumatosis coli secondary to local tumor depositions. Lymphoma is now a well-described complication of chronic ulcerative colitis, and a further case is described here. Although colonic lymphoma is a relatively rare tumor, the spectrum of radiologic changes reviewed here may enable a more accurate radiologic diagnosis.