Primary T-cell lymphoma associated with tubulovillous adenoma of the rectum: report of a case

Tiny but Mighty: Collision Tumor of a Superficial Adenocarcinoma Arising From a Tubulovillous Adenoma with Associated Low-Grade Follicular Lymphoma

Collision tumors are rare and there have only been a few previously described cases between an intestinal adenoma and a lymphoma. We report the first case of a 74-year-old woman who on investigation for iron deficiency had a tubulovillous adenoma with underlying follicular lymphoma. The atypical lymphoid proliferation showed immunohistochemical positivity for cluster of differentiation 20 (CD20), B-cell lymphoma 2 (BCL2), and B-cell lymphoma 6 (BCL6). Subsequent right hemicolectomy showed a superficially invasive adenocarcinoma.

Surgical Resection for Primary Rectal Lymphoma: Support for Local Excision?

BACKGROUND

Primary rectal lymphoma is an uncommon and heterogeneous malignancy. Because of its rarity, few data exist to guide treatment or counsel patients. We present the largest series to date of patients undergoing nonpalliative surgery for rectal lymphoma. We hypothesize that there will be no difference in overall survival between patients undergoing local resection (LR) or radical resection (RR).

MATERIALS AND METHODS

The National Cancer Data Base was queried for all cases of resected primary rectal lymphoma between years 2004 and 2014. Exclusion criteria included patients with stage IV disease and those operated on for palliation. Patients were categorized by resection approach-LR or RR. Approach along with demographic, histologic, and hospital-level factors were analyzed with a Cox proportional hazard analysis.

RESULTS

A total of 233 patients were identified. Mean age was 63 y (interquartile range 53-73), and 57% of the population was female. The most common histologic subtypes were marginal (44%), diffuse large B-cell (20%), and follicular lymphoma (17%). Eighty-seven percent underwent LR. There was no significant difference in R0 resection (LR: 38% versus RR: 58%; P = 0.07), adjuvant chemotherapy (LR: 18% versus RR: 29%; P = 0.22), or adjuvant radiation (LR: 21% versus RR: 16%; P = 0.63) between the groups. Five-year overall survival was 79%, and there was no significant difference in approach (LR: 81% versus RR: 56%, P = 0.06). Multivariable analysis did not identify an association between approach and overall survival.

CONCLUSIONS

Surgical resection of rectal lymphoma is rare. Our data support consideration of LR when possible, given the lack of convincing survival benefit of radical surgery or R0 resection.

Primary diffuse large B-cell lymphoma developing within a rectal tubular adenoma with low-grade dysplasia: a case report

Introduction

Colorectal lymphomas represent only 5% to 10% of gastrointestinal lymphomas, after the stomach and small intestine. Primary lymphoma of the colon and rectum is an unusual observation, constituting only 0.2% to 0.5% of all malignant tumors arising from the colorectal region. Very little is known about the correlation between adenoma and lymphoma in the colorectal tract. We report here a rare case of diffuse large B-cell lymphoma developing within a solitary tubular adenoma with low-grade dysplasia of the rectum.

Case presentation

An 83-year-old Caucasian man was referred to our hospital intermittent anal bleeding and irregular bowel. Colonoscopy revealed a 1cm solitary rectal polyp, which was completely removed by endoscopic resection. Histologic studies revealed low-grade intraepithelial dysplasia; the stroma of adenoma showed focal localization by highly proliferative lymphoid cells. Immunohistochemical analyses demonstrated that lymphoid cells were positive for CD20 and bcl2, whereas they were negative for CD3, CD5, CD10, CD23, CD30, CD138 and cyclin D1. Approximately 90% of the neoplastic cells reacted positively when stained with an antibody to Ki-67. Molecular studies showed the presence of a monoclonal immunoglobulin heavy chain gene rearrangement.

To determine primary or secondary lymphoma localization, Dawson’s criteria were applied to the case. A diagnosis of primary diffuse large B- lymphoma Ann Arbor stage 1A was established. Subsequently, the patient was referred to oncology to establish the stage and to select appropriate treatment.

Conclusions

The case of diffuse large B-cell lymphoma developing within a tubular adenoma, as reported here, is considered a rare event. Little about the prognosis of primary colorectal lymphomas is available and therapeutic treatment protocol is unclear. This case report provides more information on the history and macroscopic appearance of lymphomas presenting in an unusual location. To report additional cases in the future would be helpful in redefining the diagnostic, prognostic and therapeutic approach.