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Westbrook AM, Szakmary A, Schiestl RH. Mechanisms of intestinal inflammation and development of associated cancers: lessons learned from mouse models. Mutat Res 2010; 705:40-59. [PMID: 20298806 PMCID: PMC2878867 DOI: 10.1016/j.mrrev.2010.03.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/21/2010] [Accepted: 03/08/2010] [Indexed: 12/15/2022]
Abstract
Chronic inflammation is strongly associated with approximately 1/5th of all human cancers. Arising from combinations of factors such as environmental exposures, diet, inherited gene polymorphisms, infections, or from dysfunctions of the immune response, chronic inflammation begins as an attempt of the body to remove injurious stimuli; however, over time, this results in continuous tissue destruction and promotion and maintenance of carcinogenesis. Here we focus on intestinal inflammation and its associated cancers, a group of diseases on the rise and affecting millions of people worldwide. Intestinal inflammation can be widely grouped into inflammatory bowel diseases (ulcerative colitis and Crohn's disease) and celiac disease. Long-standing intestinal inflammation is associated with colorectal cancer and small-bowel adenocarcinoma, as well as extraintestinal manifestations, including lymphomas and autoimmune diseases. This article highlights potential mechanisms of pathogenesis in inflammatory bowel diseases and celiac disease, as well as those involved in the progression to associated cancers, most of which have been identified from studies utilizing mouse models of intestinal inflammation. Mouse models of intestinal inflammation can be widely grouped into chemically induced models; genetic models, which make up the bulk of the studied models; adoptive transfer models; and spontaneous models. Studies in these models have lead to the understanding that persistent antigen exposure in the intestinal lumen, in combination with loss of epithelial barrier function, and dysfunction and dysregulation of the innate and adaptive immune responses lead to chronic intestinal inflammation. Transcriptional changes in this environment leading to cell survival, hyperplasia, promotion of angiogenesis, persistent DNA damage, or insufficient repair of DNA damage due to an excess of proinflammatory mediators are then thought to lead to sustained malignant transformation. With regards to extraintestinal manifestations such as lymphoma, however, more suitable models are required to further investigate the complex and heterogeneous mechanisms that may be at play.
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Affiliation(s)
- Aya M. Westbrook
- Molecular Toxicology Interdepartmental Program, UCLA School of Medicine and School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095
- Department of Pathology and Lab Medicine, UCLA School of Medicine and School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095
| | - Akos Szakmary
- Institute for Cancer Research, Medical University of Vienna, Austria
| | - Robert H. Schiestl
- Molecular Toxicology Interdepartmental Program, UCLA School of Medicine and School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095
- Department of Pathology and Lab Medicine, UCLA School of Medicine and School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095
- Institute for Cancer Research, Medical University of Vienna, Austria
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Primary CD56+ NK/T-cell lymphoma of the rectum accompanied with refractory ulcerative colitis. J Gastroenterol 2008; 43:576-80. [PMID: 18648746 DOI: 10.1007/s00535-008-2192-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 03/16/2008] [Indexed: 02/04/2023]
Abstract
A case of primary NK/T-cell lymphoma of the rectum accompanied with ulcerative colitis (UC) in a 73-year-old man is reported. He had a 6-year history of repeated admission to our hospital for UC. Total colonoscopy performed 4 months after resolution of refractory UC complicated by cytomegalovirus colitis showed a markedly submucosal tumor in the rectum, which was histologically diagnosed as malignant lymphoma. The findings of computed tomography of the chest and abdomen, gallium scintigraphy, abdominal ultrasonography, and upper gastrointestinal endoscopy showed no abnormal lesions. Therefore, based on a diagnosis of localized rectal lymphoma with UC, proctocolectomy was performed. The resected specimen showed three submucosal tumors in the rectum with local nodal involvement. Histologically, the tumors were characterized by diffusely infiltrating sheets of large atypical lymphoid cells, which were negative for CD4, CD8, and CD20 but were positive for CD56, CD3, and granzyme B. The presence of Epstein-Barr virus (EBV) infection in neoplastic cells was shown by in situ hybridization for EBV-encoded early small RNA1 (EBER-1). Based on these findings, the patient was diagnosed with primary CD56+ NK/T-cell lymphoma of the rectum (stage IIE). This is the first case report of primary rectal NK/T-cell lymphoma accompanied with UC.
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Armstrong AM, Khosraviani K, Irwin ST, Maxwell RJ. Colonic malignancy arising in colitis - a single unit experience. Colorectal Dis 2002; 4:101-106. [PMID: 12780630 DOI: 10.1046/j.1463-1318.2002.00313.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES: Colorectal malignancy complicating inflammatory bowel disease constitutes 1% of all colorectal malignancies. Although its overall numbers are low it represents the greatest cause of colitis related mortality in these patients. This paper describes the management of 24 patients presenting to a single unit over a period of 10 years. METHODS: The names of patients were collected prospectively when they presented with malignancy. Clinical details were collected by retrospective review of charts. RESULTS: In all, 24 patients with 27 malignancies were identified. The median age of presentation with malignancy was 56 years. Most patients were treated with proctocolectomy. Other patients were treated with segmental colectomy. In these patients the surgical procedure was dictated by the stage of the cancer, the age and comorbid state of the patient and the severity of ongoing colitis. CONCLUSIONS: Malignancy arising in colitis will constitute only a small part of a colorectal practice. The optimum method for detecting early, and potentially curable, disease has not been defined. Surgery should be tailored to the individual needs of the patient.
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Affiliation(s)
- A. M Armstrong
- Department of Colorectal Surgery, The Royal Victoria Hospital, Belfast, UK
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4
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-2000. A 34-year-old man with ulcerative colitis and a large perirectal mass. N Engl J Med 2000; 343:794-800. [PMID: 10984569 DOI: 10.1056/nejm200009143431108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Frizzi JD, Rivera DE, Harris JA, Hamill RL. Lymphoma arising in an S-pouch after total proctocolectomy for ulcerative colitis: report of a case. Dis Colon Rectum 2000; 43:540-3. [PMID: 10789754 DOI: 10.1007/bf02237202] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. We present a case of a 50-year-old male with primary B cell lymphoma arising in an S-pouch eight years after a total proctocolectomy for ulcerative colitis. After chemoradiotherapy the patient remained asymptomatic, with an intact S-pouch. Pouch conservation is feasible in patients with primary lymphoma of the pouch, using chemoradiotherapy and close follow-up examinations.
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Affiliation(s)
- J D Frizzi
- Department of Surgery and Pathology, Eisenhower Army Medical Center, Fort Gordon, Georgia 30905, USA
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Abstract
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.
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Affiliation(s)
- G A Young
- Kanematsu Laboratories, Royal Prince Alfred Hospital, Department of Medicine, Camperdown, NSW 2050, Australia.
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7
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Kelly MD, Stuart M, Tschuchnigg M, Turner J, Tydd T. Primary intestinal Hodgkin's disease complicating ileal Crohn's disease. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1997; 67:485-9. [PMID: 9236620 DOI: 10.1111/j.1445-2197.1997.tb02020.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An unusual primary intestinal lymphoma that occurred as a complication of ileal Crohn's disease is presented. Immunohistochemistry confirmed the light microscopic diagnosis of Hodgkin's disease (nodular sclerosing), and characterized a distinct mucosal nodule as a large-cell anaplastic non-Hodgkin's lymphoma. This unusual lymphoma developed while the patient was being treated with immunosuppressant medication. The present report is a reminder to clinicians of the possibility of occult lymphoma in ileal Crohn's disease.
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Affiliation(s)
- M D Kelly
- Department of Colon and Rectal Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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Robert ME, Kuo FC, Longtine JA, Sklar JL, Schrock T, Weidner N. 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. Am J Surg Pathol 1996; 20:1024-31. [PMID: 8712289 DOI: 10.1097/00000478-199608000-00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- M E Robert
- Department of Pathology, University of California at San Francisco, USA
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Tsutsuml Y, Nakamura M, Machimura T. CD30-positive T cell lymphoma of the intestine, complicating ulcerative colitis. Pathol Int 1996; 46:384-8. [PMID: 8809887 DOI: 10.1111/j.1440-1827.1996.tb03626.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Y Tsutsuml
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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Ludmerer KM, Kissane JM. Right lower quadrant pain in a 31-year-old woman with ulcerative colitis. Am J Med 1995; 98:291-302. [PMID: 7872347 DOI: 10.1016/s0002-9343(99)80377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- K M Ludmerer
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Lenzen R, Borchard F, Lübke H, Strohmeyer G. Colitis ulcerosa complicated by malignant lymphoma: case report and analysis of published works. Gut 1995; 36:306-10. [PMID: 7883235 PMCID: PMC1382423 DOI: 10.1136/gut.36.2.306] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 51 year old woman with a two year history of ulcerative colitis developed a wide spread gastrointestinal non-Hodgkin's lymphoma of low grade malignancy (MALT-lymphoma) involving upper and lower gastrointestinal tract, spleen, and bone marrow. After chemotherapy, clinical symptoms improved and lymphocytic infiltrates disappeared. Thirty nine cases of ulcerative colitis and 22 cases of Crohn's disease complicated by gastrointestinal lymphomas reported in published works are reviewed. In inflammatory bowel diseases any dense lymphocytic infiltrates seen in biopsy specimens obtained from ulcerative colitis or Crohn's disease should be assessed to exclude gastrointestinal lymphoma.
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Affiliation(s)
- R Lenzen
- Department of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
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Vanbockrijck M, Cabooter M, Casselman J, Vanvuchelen J, Van Hoof A, Michielssen P. Primary Hodgkin disease of the ileum complicating Crohn disease. Cancer 1993; 72:1784-9. [PMID: 8348509 DOI: 10.1002/1097-0142(19930901)72:5<1784::aid-cncr2820720544>3.0.co;2-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Primary gastrointestinal lymphoma currently is considered to be an uncommon complication of chronic inflammatory bowel disease. All tumors reported in which recently developed techniques, such as immunohistochemical markers, were used for lymphoma classification proved to be non-Hodgkin lymphomas. Gastrointestinal lymphomas developing in Crohn disease are a very heterogeneous group, with tumors of both B-cell and T-cell lineage represented, along with some tumors of equivocal phenotype. By contrast, gastrointestinal lymphomas complicating ulcerative colitis all have proved to be so-called polymorphic B-cell lymphomas. METHODS The current report describes another case of primary gastrointestinal lymphoma complicating chronic inflammatory bowel disease occurring in the ileum of a 34-year-old man with a 3-year history of Crohn disease. RESULTS Histopathologic findings were in keeping with nodular sclerosing Hodgkin disease. Broad birefringent collagen bands divided the tumor into well-defined nodules consisting of typical Reed-Sternberg cells and lacunar variants admixed with a polymorphous lymphoid infiltrate. By immunohistochemical studies, Reed-Sternberg cells and lacunar variants stained positively for Leu-M1 (CD15) and Ber H2 (CD30). The background lymphocytes were primarily of T-cell phenotype. CONCLUSIONS To the knowledge of the authors, this article reports the first case of primary gastrointestinal Hodgkin disease in association with chronic inflammatory bowel disease that has been confirmed by immunohistochemical studies.
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McCullough JE, Kim CH, Banks PM. Mantle zone lymphoma of the colon simulating diffuse inflammatory bowel disease. Role of immunohistochemistry in establishing the diagnosis. Dig Dis Sci 1992; 37:934-8. [PMID: 1587200 DOI: 10.1007/bf01300394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe the first reported case of mantle zone lymphoma of the colon presenting as diffuse ileocolitis simulating severe inflammatory bowel disease. This case serves to illustrate the importance of immunohistochemistry in establishing the diagnosis of lymphoma in extranodal sites.
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Affiliation(s)
- J E McCullough
- Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
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