Malignant lymphoma of the rectum treated preoperatively with hyperthermia and radiation

Primary Rectal Lymphoma as a Cause of Bowel Obstruction Report of a Case

Background

Malignant lymphoma involving the rectum either as a localized process or as a manifestation of disseminated disease is rare. Several treatments have been proposed and reported, including surgical resection alone or associated with adjuvant chemoradiation, chemotherapy alone, and radiotherapy alone.

Methods

A case of bowel obstruction caused by a primary rectal MALT lymphoma is reported. Following emergency loop sigmoid colostomy the patient was started on multiple specific cycles of chemotherapy according to the MACOP-B protocol.

Results

At the end of chemotherapy a remarkable reduction in the size of the tumor was noted. Subsequently the patient underwent an ultralow anterior resection followed by a straight coloanal anastomosis. At 36 months of follow-up the patient is alive with no tumor recurrence.

Conclusions

The present report describes the unique case of a patient with primary obstructing rectal lymphoma treated with neoadjuvant chemotherapy and sphincter-saving curative surgery.

Primary colorectal lymphoma: An overview

Lymphomas represent common hematological malignancies with increasing incidence in recent years. The major site of extranodal non-Hodgkin lymphoma is the gastrointestinal tract. Involvement of the large intestine is rare in comparison to the stomach or small bowel. The disease appears later in life, predominantly in the male population. Complaints are nonspecific, requiring a high index of suspicion in order to establish the diagnosis. The treatment varies from chemotherapy alone to multimodal therapies combining surgery, chemotherapy and radiotherapy. The small number of patients with various histological subtypes and different stage at presentation results in unclear protocol for the treatment of primary colorectal lymphoma. The purpose of this paper is to review current data on primary lymphoma of the colon and rectum while analyzing reported case series and published material on the subject.

Role of chemotherapy in the management of primary rectal lymphoma: a case report and review of the literature

INTRODUCTION

Primary rectal lymphoma is a rare disease. In this paper we present an unusual case of primary rectal lymphoma which was managed with chemotherapy and discussed by a thorough review of the related literature.

CASES PRESENTATION

An 85-years-male patient was diagnosed in Sidi Mohammed Ben Abdellah Hospital as having diffuse large B-cell lymphoma of the rectum at a bulky stage two. This patient was managed successfully with 8 treatment cycles of Cyclophosphamide 750 mg/m2 at day 1 of each cycle, Doxorubicin (50 mg/m2 in the first 4 cycles and 25 mg/m2 in the subsequent cycles) at day 1 of each cycle, Vincristine 1.4 mg/m(2 )at day 1 of each cycle, and prednisone 50 mg/m(2 )at day 1 to 5 of each cycle.

CONCLUSION

The optimal treatment of primary rectal lymphoma needs more research studying to be achieved.

[Primary colorectal lymphomas]

BACKGROUND/AIM

Colorectal lymphoma is a rare tumor representing 1.4% of human lymphomas, 10-20% of gastrointestinal lymphomas, namely 0.2-0.6% of all malignancies in the colon. The aim of this study was to review clinical characteristics of primary colorectal lymphoma and overall survival.

METHODS

A detailed analysis of 16 surgically treated patients included patients age, symptoms and signs, tumor site, type of surgery, histopathologic findings, diagnosis of the disease, disease stage, type of surgery related to the degreee of emergency (elective or urgent), applied adjuvant therapy, patient follow-up and treatment outcomes. Survival was expressed by the Kaplan-Meier curve, while the difference in survival among the two groups by the Log-rank test.

RESULTS

The all patients were on an average followed-up for a median of 29 months (range 2-60 months), while those with chemotherapy 48 months (range 4-60 months). An overall mean survival time was 38.65 months.

CONCLUSION

Primary colorectal lymphoma is a rare malignant tumor of the large bowel. Therapy usually involves resection of the affected colon or rectum and regional lymphovascular structures, followed by adjuvant therapy. Survival period is short and, therefore, timely diagnosis is crucial in early disease stages when the probability of cure is high.

Intraoperative radiation therapy for a patient with bulky disease of mesenteric non-Hodgkin's lymphoma

A long survival is rarely observed in patients demonstrating recurrent malignant lymphoma with bulky disease because of the appearance of chemoresistant tumor cells after extensive chemotherapy, and moreover the presence of bulky disease has also been consistently associated with a poorer response rate and a shortened survival, due to the fact that tumor size is the most significant factor for the treatment of non-Hodgkin's lymphoma. We herein describe a case of a 53-year-old woman presenting with the chief complaint of abdominal fullness, who underwent intraoperative radiation therapy (IORT) for recurrent bulky non-Hodgkin's lymphoma in the mesenterium. The patient has had no evidence of tumor recurrence, based on the findings of regular abdominal computed tomographic scans, 60 months after initial chemotherapy and 28 months after IORT.

Primary malignant lymphoma of the rectum with distant metastasis to the stomach: report of a case

Primary extranodal malignant lymphoma frequently occurs in the gastrointestinal tract: however, it is rarely encountered in the rectum. We report herein the case of an 85-year-old man who underwent abdominoperineal resection for primary malignant lymphoma of the rectum, and 1 year later, developed hematemesis caused by gastric metastasis. To our knowledge this is the first case report of such distant metastasis developing from malignant lymphoma of the rectum.