1
|
Hasturk D, Akturk Esen S, Buyukaksoy M, Civelek B, Seven I, Uncu D. Primary colon lymphomas: An analysis of our experience over the last 18 years. Medicine (Baltimore) 2024; 103:e38013. [PMID: 38728507 PMCID: PMC11081556 DOI: 10.1097/md.0000000000038013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Colon lymphoma is a rare type of gastrointestinal lymphoma and represents 0.2% to -1.2% of all primary colon cancers. This study aimed to retrospectively examine the general characteristics, treatment methods, and survival characteristics of patients with colon lymphoma who were followed-up at our center. This retrospective study included patients diagnosed with colon lymphoma who were followed up at Ankara Numune Training and Research Hospital and Ankara Bilkent City Hospital between December 2005 and June 2023. Clinicopathological features, radiological findings, treatments, and modalities of patients were obtained from their medical records. Fourteen patients with primary colon lymphoma were included in the study. Thirteen patients (92.9%) were diagnosed with diffuse large B-cell lymphoma. The median age of the patients was 55 (28-84) years. The tumor location was the terminal ileum/cecum in 50% of the patients. At the time of diagnosis, 10 patients (7 with stage 1E-2E disease, 2 with stage 3E disease, and 1 with stage 4E disease due to tumor obstruction) underwent surgery. Twelve patients received chemotherapy (6 patients as adjuvant and 6 patients as first-line treatment). The median overall survival (OS) was 10 years (0.1-21.5) years, the 5-year median OS was 71%, and the 10-year median OS was 53%. Primary colon lymphoma is a rare disease and its optimal treatment is not clearly defined. The primary treatment for primary colon lymphoma is a combination of surgery and chemotherapy. A clear consensus on the treatment can be established through prospective studies.
Collapse
MESH Headings
- Humans
- Middle Aged
- Male
- Aged
- Female
- Retrospective Studies
- Colonic Neoplasms/therapy
- Colonic Neoplasms/pathology
- Colonic Neoplasms/mortality
- Adult
- Aged, 80 and over
- Lymphoma/therapy
- Lymphoma/epidemiology
- Lymphoma/diagnosis
- Lymphoma/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Staging
Collapse
Affiliation(s)
- Denizcan Hasturk
- Clinic of Internal Medicine, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Selin Akturk Esen
- Clinic of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Muge Buyukaksoy
- Clinic of Internal Medicine, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Burak Civelek
- Clinic of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ismet Seven
- Clinic of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Dogan Uncu
- Clinic of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| |
Collapse
|
2
|
Borré CI, Boyle B, Lynch K, Kanaparthi A, Csizmar CM, Larson DP, Braithwaite MD, Johnson IM, Witzig TE, Suarez DA. Burkitt Lymphoma Presenting as Ileocolic Intussusception in an Adult. OPEN JOURNAL OF BLOOD DISEASES 2023; 13:121-132. [PMID: 38361601 PMCID: PMC10868555 DOI: 10.4236/ojbd.2023.134014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Adult intussusception is rare, highly associated with a malignant lead point, and often requires emergent surgical management. We report the case of a 44-year-old male who presented with generalized abdominal pain and was found to have early ileocolic intussusception secondary to a large ileocecal mass. Biopsies of the mass and an enlarged cardiophrenic lymph node, as well as pleural fluid cytology were all consistent with Burkitt lymphoma (BL). Curiously, the patient's abdominal exam was reassuring, and the intussusception and malignant bowel obstruction resolved over 36 hours with conservative management alone. With a Burkitt lymphoma international prognostic index (BL-IPI) score of 2, the patient proceeded to treatment with combination chemoimmunotherapy and attained a complete response after four cycles. There was no bowel perforation or recurrent intussusception throughout treatment. Thus, this report marks the first reported case of adult BL-associated intussusception to resolve with non-invasive management and establishes a precedent for conservative management in select patients.
Collapse
Affiliation(s)
| | | | - Kelsey Lynch
- Department of Medicine, Mayo Clinic, Rochester, USA
| | | | | | - Daniel Philip Larson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | | | | | | | - Diego Armando Suarez
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, USA
| |
Collapse
|
3
|
Chen CW, Chen YY, Chen YF. Multiple Synchronous Mucosa-Associated Lymphoid Lymphomas Involving in the Stomach, Duodenum, Ileum, and Sigmoid. Diagnostics (Basel) 2022; 12:diagnostics12123150. [PMID: 36553157 PMCID: PMC9776997 DOI: 10.3390/diagnostics12123150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Gastric MALToma is an extra-nodal marginal-type B-cell lymphoma. MALToma may occur secondary to chronic inflammation and autoimmunity. The most common gastrointestinal (GI) site of MALToma is the stomach, with approximately 50% of lesions occurring there. Synchronous upper and lower GI MALTomas rarely occur, with few cases reported. We present the case of a 67-year-old patient who presented asymptomatic and was found to have synchronous multifocal upper and lower GI MALTomas in the stomach, duodenum, terminal ileum, and sigmoid, which did not respond to H. Pylori eradication therapy.
Collapse
Affiliation(s)
- Chun-Wei Chen
- Division of Gastroenterology, Yuan Lin Christian Hospital, Yuanlin City 510, Taiwan
| | - Yang-Yuan Chen
- Endoscopic Center, Changhua Christian Hospital, 3 Lane 138 Tai-An 2nd Street, Changhua City 500, Taiwan
- Yuan Lin Branch, Department of Hospitality Management, MingDao University, Changhua City 523, Taiwan
- Correspondence:
| | - Yung-Fang Chen
- Division of Radiology, China Medical University, China Medical University Hospital, Taichung City 404, Taiwan
| |
Collapse
|
4
|
German BD, Akin J, Kim SH, Murphy C, Venugopal P, Lopez-Hisijos N, Katz DA. Iatrogenic Immunodeficiency Associated Lymphoproliferative Disorder in a Patient With Inflammatory Bowel Disease. J Med Cases 2022; 13:521-524. [PMID: 36407867 PMCID: PMC9635768 DOI: 10.14740/jmc3798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/17/2022] [Indexed: 01/25/2023] Open
Abstract
Primary colorectal lymphoma is incredibly rare and cases of iatrogenic immunodeficiency associated lymphoproliferative disorder (IILPD) isolated to colorectal area are even more uncommon. Immunodeficiency associated lymphoproliferative disorders can occur in association with primary immune disorders such as inflammatory bowel diseases (IBDs) which are often treated with various immunomodulatory drugs. Of the immunomodulatory drugs, thiopurines, in particular, are known to have a significantly increased relative risk for development of IILPDs. Here we present the case of a 43-year-old Caucasian man with a 22-year history of IBD treated with longstanding immunomodulatory therapy who presented with severe rectal pain and drainage. He underwent an examination under anesthesia with rigid proctoscopy and biopsies were taken of a hard exophytic appearing tissue along the posterior wall of the rectosigmoid junction. Pathological investigation of the samples revealed IILPD. He underwent treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) and achieved complete remission. Literature demonstrates that the use of immunomodulators such as azathioprine has been shown to significantly improve the quality of life in patients with IBD. However, while the absolute risk of lymphoma for any given patient remains quite low, the relative risk of lymphoma in patients who are actively treated with thiopurines is moderate. Therefore, the decision to proceed with thiopurine treatment, especially in the setting of long-term therapy, requires extensive discussion and patient education of the risks/benefits along with closer monitoring of new or uncharacteristic symptoms.
Collapse
Affiliation(s)
- Benjamin D. German
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Seo-Hyun Kim
- Division of Hematology, Oncology and Cellular Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Caitlin Murphy
- Division of Hematology, Oncology and Cellular Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Parameswaran Venugopal
- Division of Hematology, Oncology and Cellular Therapy, Rush University Medical Center, Chicago, IL, USA
| | | | - Deborah A. Katz
- Division of Hematology, Oncology and Cellular Therapy, Rush University Medical Center, Chicago, IL, USA,Corresponding Author: Deborah Katz, Division of Hematology/Oncology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| |
Collapse
|
5
|
Utility of PET Scans in the Diagnosis and Management of Gastrointestinal Tumors. Dig Dis Sci 2022; 67:4633-4653. [PMID: 35908126 DOI: 10.1007/s10620-022-07616-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
|
6
|
Primary diffuse large B-cell lymphoma of the sigmoid colon. Int J Surg Case Rep 2021; 87:106454. [PMID: 34600235 PMCID: PMC8488484 DOI: 10.1016/j.ijscr.2021.106454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022] Open
Abstract
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. Non-Hodgkin lymphoma is the most common type of colonic lymphoma. Extranodal lymphomas of the colon and rectum are rare. Histopathological evaluation is important for subtyping of lymphoma. Chemotherapy is the main form of treatment but sometimes surgery is required.
Collapse
|
7
|
Pande S, Patne SC. Primary Rectal Lymphoma: A Case Report and Review of Literature. Indian J Nucl Med 2021; 36:422-424. [PMID: 35125760 PMCID: PMC8771074 DOI: 10.4103/ijnm.ijnm_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Lymphomas represent common hematological malignancy, and depending on site, they are classified as nodal or extranodal lymphoma. The term extranodal disease refers to lymphomatous infiltration of anatomic sites other than the primary lymphatic sites; however, the diagnosis of primary versus secondary extranodal lymphoma remains challenging. Among the extranodal locations, gastrointestinal system is the most frequent site. The involvement of the stomach, small intestine, and colon is noted. Rectum as primary site for lymphoma is rare in adults and extremely rare in children. We describe a case of primary rectal lymphoma (high-grade B-cell non-Hodgkin's lymphoma) in 11-year-old child. We believe that reporting this case will add to the data about clinical presentation, radiological, nuclear medicine findings, and treatment approaches of primary rectal lymphoma.
Collapse
Affiliation(s)
- Shantanu Pande
- Department of Nuclear Medicine, Mahamana Pandit Madanmohan Malaviya Cancer Centre, Homi Bhabha Cancer Hospital, BHU Campus, Varanasi, Uttar Pradesh, India
| | - Shashikant Cu Patne
- Department of Pathology, Mahamana Pandit Madanmohan Malaviya Cancer Centre, Homi Bhabha Cancer Hospital, BHU Campus, Varanasi, Uttar Pradesh, India
| |
Collapse
|
8
|
Chen L, Sun Q, Chen E, Jin D, Song Z. Primary colonic lymphoma: report of two cases and a literature review. J Int Med Res 2021; 49:3000605211017037. [PMID: 34082600 PMCID: PMC8182193 DOI: 10.1177/03000605211017037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary colonic lymphoma is a very rare malignant tumor with no standard treatment. We
report two cases of primary colonic lymphoma successfully treated with surgery and
chemotherapy, and chemotherapy alone, respectively. The first case was a 61-year-old woman
who presented with abdominal pain of more than 1 month. The patient was diagnosed with a
colonic tumor, and immunohistochemical examinations confirmed the initial diagnosis of
colonic lymphoma. The patient underwent laparoscopic-assisted right hemicolectomy followed
by postoperative adjuvant chemotherapy with the cyclophosphamide, doxorubicin,
vincristine, and prednisone (CHOP) regimen, combined with targeted therapy with rituximab
(R-CHOP). The second case was a 78-year-old man who presented with a complaint of
abdominal distention for more than 1 year. Diffuse large B-cell lymphoma was definitively
diagnosed by immunohistochemical examinations, and the patient underwent systemic
chemotherapy with the R-CHOP regimen. Primary colonic lymphoma is a rare type of
non-Hodgkin's lymphoma (NHL), and the clinical treatment is not standardized, unlike for
many other types of lymphoma. Therefore, treatment is mainly based on the patient’s
symptoms to determine whether surgery or systemic chemotherapy is appropriate. Rituximab
is effective in some patients and may play an important role in the treatment of
unresectable or asymptomatic colonic lymphoma.
Collapse
Affiliation(s)
- Li Chen
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Sun
- Department of Colorectal Surgery, Zhuji People's Hospital of Zhejiang Province, China
| | - Engeng Chen
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongai Jin
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhangfa Song
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
9
|
Shirwaikar Thomas A, Schwartz M, Quigley E. Gastrointestinal lymphoma: the new mimic. BMJ Open Gastroenterol 2019; 6:e000320. [PMID: 31645987 PMCID: PMC6782046 DOI: 10.1136/bmjgast-2019-000320] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Gastrointestinal (GI) lymphomas comprise a group of distinct clinicopathological entities of B- or T- cell type, with primary gastrointestinal Hodgkin lymphoma being extremely uncommon. The GI tract is the predominant site of extranodal non-Hodgkin lymphoma accounting for 30–40% of all extranodal lymphomas. In the Western world, the stomach is the most commonly involved site followed by the small bowel. Several chronic inflammatory and immune-mediated disorders which predispose to accelerated cell turnover may lead to the malignant transformation of gut lymphocytes and ultimately manifest as GI lymphoma. The challenge for the clinical gastroenterologist is that these tumors may have varied presentations, ranging from nonspecific symptoms such as dyspepsia or bloating to abdominal pain, nausea, vomiting, GI bleeding, diarrhea, weight loss or bowel obstruction. Objective We illustrate the range of presentations of GI lymphoma with examples based on consecutive cases evaluated at our institution over a 6-month period. These cases demonstrate how appropriately directed endoscopic evaluation with biopsies has the potential to provide a definitive diagnosis and allow the patient to proceed to definitive therapy. Conclusions The GI tract is the most commonly involved site for extranodal lymphoma with the stomach being most frequently involved organ. Chronic Helicobacter pylori infection, celiac disease, inflammatory bowel disease and autoimmune disorders may predispose to GI lymphoma. This heterogenous group of diseases has varied presentations that may mimic several other GI clinico-pathologic entities. GI lymphomas may be diagnosed with appropriately directed endoscopic evaluation coupled with generous tissue sampling and expert pathologic assessment. Management may range from antibiotic therapy, in the case of Helicobacter pylori-associated gastric MALT lymphoma, to chemotherapy with or without radiation and, in rare instances, surgery. There are presently no guidelines to direct endoscopic surveillance of GI lymphomas following treatment.
Collapse
Affiliation(s)
- Anusha Shirwaikar Thomas
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary Schwartz
- Hepatology and Nutrition, Houston Methodist Hospital, Houston, Texas, USA
| | - Eamonn Quigley
- Hepatology and Nutrition, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
10
|
Rao P, Kaniyarakkal P, Kamalesh NP, Prasanna BK, Kulshrestha K, Deepak GT, Ponnambathayil S, Iype S. Starry Rectum: a Rare Case of Adult Primary Rectal Burkitt’s Lymphoma in the Setting of Crohn’s Disease with Literature Review. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01868-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
11
|
Yildirim N, Turkeli M, Akdemir MN, Simsek M, Tekin SB. Evaluation of 22 Primary Gastrointestinal Lymphoma Patients. Eurasian J Med 2019; 51:53-56. [PMID: 30911257 DOI: 10.5152/eurasianjmed.2019.16071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Primary gastrointestinal non-hodgkin lymphomas (PGI-NHL) are uncommon diseases with treatment modalities including chemotherapy, surgery, and radiotherapy. Our aim is to analyze the demographic and clinical features and treatment results of PGI-NHL. Materials and Methods 286 patients diagnosed with lymphoma who referred to Ataturk University Medical Faculty Hospital between July 2001 and April 2014 were surveyed retrospectively and 22 (7.6%) PGI-NHL cases whose primary lesions were in gastrointestinal system were included. Results Mean age was 47 (min.25-max.77) and 14 (63.6%) of them were men. The origin was determined as small intestines (50%), stomach (31.8%) and colon (18.2%), respectively. The most common complaint and pathologic subtype were abdominal pain (68.2%) and diffuse large B cell lymphoma (86.4%), respectively. The Lugano Classification was as follows: stage 1 (18.2%), stage 2 (59.1%), and stage 4 (22.7%). Surgery and chemotherapy were administered to 40.9% of patients. Complete and partial response and disease progression were established in 72.1%, 4.5% and 13.6% of the patients, respectively. Mean survival time was 99.6±16 months. Mean overall survival time was determined significantly longer in small bowel group than gastric group (119±15 vs. 50±24 months) (p=0.039). Age, gender, Eastern Cooperative Oncology Group performance status, International Prognostic Index, stage, histological type, tumor size, LDH level, albumin level, Hemoglobin level and treatment options were not associated with survival. Conclusion Demographic and clinical characteristics of our series were similar with Middle Eastern and African countries. Optimal treatment options or prognostic factors for PGI-NHL are not clear. There is a need for randomized prospective studies including large number of patients and long follow-up period.
Collapse
Affiliation(s)
- Nilgun Yildirim
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Turkeli
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Naci Akdemir
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Melih Simsek
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Salim Basol Tekin
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| |
Collapse
|
12
|
Cai YB, Chen HY, He JJ, Hu YT, Yang Q, Chen LB, Xiao Q, Ding KF. The role of surgical intervention in primary colorectal lymphoma: A SEER population-based analysis. Oncotarget 2018; 7:72263-72275. [PMID: 27708217 PMCID: PMC5342160 DOI: 10.18632/oncotarget.12344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 08/08/2016] [Indexed: 12/26/2022] Open
Abstract
Background Primary colorectal lymphoma (PCL) is a rare colorectal malignancy. The standard treatment and prognostic factors of PCL remain unexplored. Therefore, a large population-based study should be conducted to provide a detailed review of this disease. Methods We extracted the data of eligible patients with PCL registered in the SEER database from 1973 to 2011. All statistical analyses were performed using SPSS 19.0. Results A total of 2050 (61.3%) of the 3342 patients with PCL underwent surgical intervention, and 1292 (38.7%) patients received no surgical treatment. The median overall survival was 95 months, and patients receiving surgery exhibited significantly prolonged survival (adjusted HR =0.69, P <0.001). Young age, early tumor stage, and indolent lymphoma were independent predictors of improved survival. Further survival analyses demonstrated the potential benefit of surgery in patients with early tumor stage, right-sided lesions, or diffuse large B-cell PCL. Conversely, surgical intervention did not improve the survival of patients with advanced-stage, left-sided, or indolent PCL. Conclusion PCL is a rare tumor that can be effectively treated. Surgical intervention may play an important role in the treatment of PCL. Early tumor stage, a right-sided lesion, and diffuse large B-cell histological PCL seem to be the clinical characteristics of optimal surgical candidates.
Collapse
Affiliation(s)
- Yi-Bo Cai
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hai-Yan Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jin-Jie He
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ye-Ting Hu
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qi Yang
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liu-Bo Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Xiao
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ke-Feng Ding
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
13
|
Alagöz E, Okuyucu K, İnce S, Kantarcıoğlu M, Özaydın Ş, Heper C, Türker T, Arslan N. Uptake Patterns of Untreated Primary Gastrointestinal Extranodal Lymphomas on Initial Staging 18F-FDG PET/CT and Metabolic Tumor Parameters. Mol Imaging Radionucl Ther 2017; 26:83-92. [PMID: 28976330 PMCID: PMC5643944 DOI: 10.4274/mirt.48658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: Non-Hodgkin’s lymphomas arising from tissues other than primary lymphatic sites are classified as primary extranodal lymphomas (PEL). PELs of the gastrointestinal system (PGISL) originate from the lymphatic tissues within the gastrointestinal tract. The prognostic value of 18F-FDG PET/CT in lymphomas is high in terms of both overall survival (OS) and disease-free survival (DFS). Our aim was to investigate the uptake patterns and properties of low-grade and high-grade PGISL on primary staging 18F-FDG PET/CT, as well as the prognostic significance of metabolic tumor parameters in high grade PGISL. Methods: Thirty-nine patients with PGISL were enrolled in this retrospective cohort study between 2004-2015. Primary staging 18F-FDG PET/CT have been performed and quantitative parameters of SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been calculated for all patients prior to treatment. Low-grade and high-grade PGISL were compared in terms of metabolic tumor parameters. Cox regression models were performed to determine factors that correlate with DFS in high-grade PGISL. Results: There were statistically significant differences between high-grade and low-grade PGISL in terms of SUVmax, SUVmean, MTV, TLG, recurrence, mortality, DFS and OS. None of the potential risk factors (sex, age, site, SUVmax, SUVmean, MTV, TLG) for recurrence and metastasis in high grade PGISL was identified as a risk factor on univariate and multivariate Cox regression analysis. Conclusion: Metabolic tumor parameters are not predictive markers in high-grade PGISL, especially in diffuse large B cell variant and primary gastric lymphoma. The first implications suggest they will not play a role in patient management.
Collapse
Affiliation(s)
- Engin Alagöz
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Kürşat Okuyucu
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Semra İnce
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Murat Kantarcıoğlu
- Gülhane Training and Research Hospital, Clinic of Gastroenterology, Ankara, Turkey
| | - Şükrü Özaydın
- Gülhane Training and Research Hospital, Clinic of Medical Oncology, Ankara, Turkey
| | - Cumhur Heper
- İstanbul University Institute of Cardiology, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Türker Türker
- Gülhane Training and Research Hospital, Clinic of Public Health, Ankara, Turkey
| | - Nuri Arslan
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| |
Collapse
|
14
|
Pyeon SI, Song GA, Baek DH, Kim GH, Lee BE, Lee SJ, Yoon JB, Han SY, Park DY. Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:139-142. [PMID: 28239083 DOI: 10.4166/kjg.2017.69.2.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The gastrointestinal tract is the most common site of extra-nodal non-Hodgkin lymphoma. However, the incidence of primary rectal lymphoma is extremely rare. Among the primary gastrointestinal lymphomas, follicular lymphoma has been described as a rare disease. It is difficult to diagnose rectal lymphoma due to its variable growth patterns and inadequate biopsies. Majority of patients with rectal lymphoma have non-specific symptoms or negative biopsies, often delaying the diagnosis. Our patient is a 62-year-old female. Two sessile and smooth subepithelial lesions with a yellowish normal mucosa were found on a screening colonoscopy. The initial mucosal biopsy finding was chronic inflammation, but we were highly suspicion of malignancy; we performed an endoscopic mucosal resection. Herein, we present a rare case of rectal follicular lymphoma diagnosed by endoscopic mucosal resection with a literature review.
Collapse
Affiliation(s)
- Sung Ik Pyeon
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seong Jun Lee
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jung Bin Yoon
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| |
Collapse
|
15
|
Abbas H, Niazi M, Makker J. Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Colon: A Case Report and a Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:491-497. [PMID: 28469125 PMCID: PMC5424574 DOI: 10.12659/ajcr.902843] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Female, 56 Final Diagnosis: Colonic MALT lymphoma Symptoms: Epigastric pain Medication: — Clinical Procedure: Colonoscopy and biopsy Specialty: Gastroenterology and Hepatology
Collapse
Affiliation(s)
- Hafsa Abbas
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, USA
| | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital Center, Bronx, USA
| | - Jasbir Makker
- Department of Medicine, Division of Gastroenterology, Bronx Lebanon Hospital Center, Bronx, USA
| |
Collapse
|
16
|
Papakonstantinou IP, Andreadis EA. Persistent Afebrile Abdominal Pain: An Unusual Case of Segmental Colitis in an Immunocompromised Host. Cureus 2017; 9:e1033. [PMID: 28357165 PMCID: PMC5354403 DOI: 10.7759/cureus.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Emmanuel A Andreadis
- 4th Internal Medicine Department, "Evangelismos" General Hospital, Athens, Greece
| |
Collapse
|
17
|
Bernardi D, Asti E, Bonavina L. Adult ileocolic intussusception caused by Burkitt lymphoma. BMJ Case Rep 2016; 2016:bcr-2016-218334. [PMID: 27920022 DOI: 10.1136/bcr-2016-218334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Ileocolic intussusception due to Burkitt lymphoma is extremely rare in adults. A man aged 17 years presented with a history of recurrent abdominal pain over the past 3 weeks. The abdomen was distended with diffuse tenderness, and bowel sounds were present. Abdominal ultrasound and CT scans showed evidence of small bowel obstruction with marked wall thickening in the ileocecal region and 'target' signs suggestive for intussusception. At laparoscopy, a mass involving the caecum and the terminal ileum was found, along with multiple locoregional nodes, which was highly suggestive of malignancy. A typical en bloc right colectomy with intracorporeal ileocolic anastomosis was performed. Histopathological examination showed a high-grade B-cell Burkitt lymphoma that was confirmed by immunohistochemistry. The patient was subsequently treated with adjuvant combination chemotherapy and is alive and disease-free at the 3-year follow-up.
Collapse
Affiliation(s)
- Daniele Bernardi
- Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milano, Italy
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Asti
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milano, Italy
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
18
|
Ge Z, Liu Z, Hu X. Anatomic distribution, clinical features, and survival data of 87 cases primary gastrointestinal lymphoma. World J Surg Oncol 2016; 14:85. [PMID: 26988370 PMCID: PMC4797173 DOI: 10.1186/s12957-016-0821-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/29/2016] [Indexed: 02/06/2023] Open
Abstract
Background The purpose of this study is to analyze the anatomic distribution, clinical features, therapeutic methods, and prognosis factors of primary gastrointestinal lymphoma (PGIL). Methods Clinical data of 87 cases PGIL in the First Affiliated Hospital of Dalian Medical University from January 1999 to December 2010 were collected. Follow-ups were made according to the clinical feature, pathological pattern, clinical stage, and therapeutic method. Kapan Meier method was used for the survival analysis. Log-rank test was used to perform univariate survival analysis. COX multivariate analysis was carried out to analyze factors of P < 0.05 in univariate survival analysis. Results The incidence of PGIL significantly increased in patients more than 40 years old (87.4 %). Clinical symptoms of PGIL were indistinguishable from other digestive system diseases, which included abdominal pain or discomfort (72.4 %), lack of appetite (16.3 %), gastrointestinal hemorrhage (14.9 %), and diarrhea (12.8 %). Some patients presented with systemic symptoms or complications, such as weight loss (35.6 %) and digestive tract obstruction (13.8 %). Primary gastric lymphoma (PGL) was the most common, followed by primary intestine lymphoma (PIL). The majority of PGIL were single lesion, which included 40 cases (87 %) PGL and 35 cases (94.5 %) PIL. The most frequent site of PGL was antrum of the stomach (43.5 %), as to PIL, the small intestine (90.2 %) was the most frequent site, especially within 100 cm far away from ileocecal valve. Most of PGIL were derived from B cell (93.1 %). The most common pathological type was mucosa-associated lymphoid tissue (MALT) (67.4 %) in the PGL group and diffuse large B cell lymphoma (DLBCL) (46.3 %) in the PIL group. Surgical treatment had been performed in most of PGIL, which included 32 cases in the PGL group and 38 cases in the PIL group. The 1-year overall survival (OS) and the 3-year OS were 82 and 77 %, respectively. Analysis of single factor affecting prognosis showed that lesion location, sources of cells, and clinical stage were associated with OS. PGL group had better OS than that of PIL group (1-year 89 vs 62 %, 3-year 84 vs 50 %, P = 0.03). B cell-originated group had better OS than that of T cell-originated group (1-year 89 vs 36 %, 3-year 85 vs 0 %, P = 0.008). Stage I + II group had better OS than that of stage III + IV group (1-year 89 vs 38 %, 3-year 87 vs 0 %, P = 0.007). Multivariate analysis showed that clinical stage and sources of cells were the significant independent prognostic factors. Conclusions It was more common to find location of PGIL in the stomach than that in the intestine. The most common pathological type was MALT in the PGL and DLBCL in the PIL. The treatment of PGL was focused on chemotherapy. It was noting that since PIL was not only difficult to make confirmed diagnosis but also likely to develop with complications, so it was usually needed surgical excision. Clinical stage and pathological pattern were related to prognosis of PGIL.
Collapse
Affiliation(s)
- Zheng Ge
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Huaihe Hospital of Henan University, Kaifeng, China
| | - Zhong Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Xiang Hu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
19
|
Zhang XX, Xu J, Jiang T, Lu Y. Diagnosis and treatment of primary gastrointestinal Burkitt-like lymphoma in adults. Shijie Huaren Xiaohua Zazhi 2016; 24:612-617. [DOI: 10.11569/wcjd.v24.i4.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the epidemiological and clinicopathological characteristics, diagnosis and treatment of primary gastrointestinal Burkitt-like lymphoma in adults.
METHODS: Relevant articles published since 1995 were retrieved in 15 English databases such as MEDLINE/PubMed, Web of Science, Directory of Open Access Journals (DOAJ) and SpringerLink and in China National Knowledge Infrastructure (CNKI) database. Data of six patients with primary gastrointestinal Burkitt-like lymphoma were obtained from six articles.
RESULTS: Four cases of adult primary gastrointestinal Burkitt-like lymphoma were from East Asia (Japan and China, 66.7%). All six patients were male with an average age of 57.6 years. Two cases occurred in the ileocecum, one in the stomach, one in the hepatic flexure of the colon, one in the terminal ileum, and one in the stomach and small intestine simultaneously. Four cases were admitted to the hospital because of abdominal mass, along with B symptoms: weight loss in four cases and fatigue in two cases. All patients underwent alimentary endoscopy (CT scan in 5 cases and B-ultrasound in 3 cases). Four cases underwent surgery, 5 cases underwent combined chemotherapy, and 3 cases underwent surgery plus postoperative chemotherapy. One case died within 1 year, and one case was followed for 5 years and is still alive. Immunohistochemically, CD20 and CD10 staining was positive in 4 cases, Ki-67 staining positive in 3 cases, Bcl-2 staining negative in 3 cases, CD23 and CD5 staining negative in 2 cases.
CONCLUSION: Adult primary gastrointestinal Burkitt-like lymphoma is a highly malignant non-Hodgkin's lymphoma and is extremely rare clinically with rapid development and high mortality. Its clinical manifestations are non-specific, so comprehensive examination should be conducted to confirm the diagnosis before clinical intervention. Final diagnosis still relies on fine-needle aspiration biopsy or surgical excision biopsy. Surgical treatment and multi-drug combination adjuvant chemotherapy postoperatively should be implemented as soon as possible after making a diagnosis. Clinicians should raise their awareness of the disease and pay more attention to the diagnosis and treatment of the disease, which could improve the outcome of the patients.
Collapse
|
20
|
|
21
|
Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
Collapse
Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
| | | | | |
Collapse
|
22
|
Dong YJ, Wu HC. Primary lymphomas of the stomach, duodenum and colon: A case report. Shijie Huaren Xiaohua Zazhi 2014; 22:5389-5392. [DOI: 10.11569/wcjd.v22.i34.5389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Synchronous gastric, duodenal and colonic primary lymphomas have a low incidence. Due to the lack of specific symptoms, missed diagnosis or misdiagnosis is easily caused. The present case was initially considered to have gastrointestinal cancer and multiple gastrointestinal polyps, but synchronous gastric, duodenal and colonic primary lymphomas were finally diagnosed by gastrointestinal endoscopy combined with pathological biopsy. Clinicians should raise their awareness of this condition, and comprehensive analysis of clinical characteristics, endoscopic manifestations, pathological characteristics, and imaging findings can help improve the level of diagnosis and treatment.
Collapse
|
23
|
Vetro C, Romano A, Amico I, Conticello C, Motta G, Figuera A, Chiarenza A, Raimondo CD, Giulietti G, Bonanno G, Palumbo GA, Raimondo FD. Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up. World J Gastroenterol 2014; 20:12993-13005. [PMID: 25278693 PMCID: PMC4177478 DOI: 10.3748/wjg.v20.i36.12993] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/28/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed.
Collapse
MESH Headings
- Animals
- Endoscopy, Gastrointestinal
- Endosonography
- Helicobacter Infections/complications
- Helicobacter Infections/microbiology
- Helicobacter pylori/pathogenicity
- Humans
- Intestinal Neoplasms/diagnostic imaging
- Intestinal Neoplasms/microbiology
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/therapy
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm Grading
- Predictive Value of Tests
- Stomach Neoplasms/diagnostic imaging
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Treatment Outcome
Collapse
|
24
|
Sadhu S, Prabhu R, Natarajan A, Vaidya K. Primary colorectal non-Hodgkin's lymphoma in a retropositive patient. BMJ Case Rep 2013; 2013:bcr-2013-200442. [PMID: 24014336 DOI: 10.1136/bcr-2013-200442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 43-year-old man known case of retropositive illness presented with abdomen pain of 15 days and loose stools for 10 days. Loose stools were foul smelling and blood stained. The patient was a known case of type 2 diabetes and retroviral illness on highly active antiretroviral therapy (HAART). General physical examination was normal. On examination an irregular mass was palpable in the right iliac fossa and right flank. The mass was hard in nature; irregular with restricted mobility. There was no palpable liver or spleen. CT of the abdomen and pelvis revealed a well-defined heterogeneously enhancing hypodense mass lesion measuring 16 × 11.7 × 12 cm involving the ileocaecal region and extending medially and inferiorly to sigmoid colon and rectum. A colonoscopy showed a proliferative highly vascular mass 15 cm from anal verge at the rectosigmoid junction. Histopathology revealed sheets of neoplastic lymphoid cells in rectal wall suggestive of non-Hodgkins lymphoma.
Collapse
Affiliation(s)
- Sakshi Sadhu
- Department of General Medicine, Kasturba Medical College, Karnataka, India
| | | | | | | |
Collapse
|
25
|
Saber MM, Zeeneldin AA, Samra MA, Farag SA. Primary gastrointestinal lymphoma in an Egyptian district: a study using a population-based cancer registry. J Egypt Natl Canc Inst 2013; 25:95-101. [PMID: 23719408 DOI: 10.1016/j.jnci.2013.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/16/2013] [Accepted: 03/17/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Gastrointestinal lymphoma (GIL) is the most common extranodal form of non-Hodgkin's lymphoma (NHL) with geographical and age variation of its various subtypes. AIM To study GIL in Gharbiah, Egypt and to recognize the treatments employed and their outcomes including survival. METHODS This is a retrospective study. Between 2000 and 2002, 40 adult patients with GIL were identified in the Gharbiah population based cancer registry (GPBCR); 26 cases of whom were treated at Tanta Cancer Center (TCC). RESULTS GIL in Gharbiah, Egypt represented 6.2% of all GIT cancers. The median age was 47 years with slight male predominance. The commonest primary site was the stomach followed by the colon/rectum then the small intestine (67.5%, 25% and 7.5%, respectively). The commonest histological subtypes were the diffuse large B-cell (41.5%) followed by marginal zone B-cell (39%). The commonest symptoms were abdominal pains followed by vomiting. Only 18% of GILs were surgically resected. Most patients (77%) received chemotherapy with a 60% complete response (CR) rate. Once in CR, relapses are occasional. The median overall survival (OS) and progression free survival (PFS) were 31 and 14 months (95% CI, 13.2-48.7 and 6.4-21.6 months, respectively). Gastric primary site and diffuse large B cell subtype carry a non-significant worse OS and PFS than those of other sites and subtypes. CONCLUSIONS GILs in Gharbiah, Egypt are characterized by predominance of male gender, gastric site and marginal zone histology. Survival is worse for gastric and diffuse large B-cell GILs compared to other sites and histologies.
Collapse
Affiliation(s)
- Magdy M Saber
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
| | | | | | | |
Collapse
|
26
|
Abstract
Extranodal lymphomas account for a third of all cases of non-Hodgkin lymphoma with the gastrointestinal tract being the most common extranodal site. The most common location is the stomach followed by the small intestine, colon and rectum. Colorectal lymphomas are rare and comprise 10-20% of all gastrointestinal lymphomas and only 1% of all colorectal malignancies. Presenting symptoms include abdominal pain, weight loss, and anorexia. Diagnosis depends on the clinical setting with elective cases being diagnosed with colonoscopy and emergent cases being diagnosed in the operating room. Colonic lymphomas are frequently located proximal to the hepatic flexure. Management depends on the aggressiveness of the lymphoma subtype. Indolent tumors, which are resistant to standard chemotherapeutic regimens, are treated with surgical resection. Aggressive lymphoma subtypes are managed with chemotherapy and surgery with late-stage disease patients being referred to clinical trials.
Collapse
|
27
|
Abstract
AIMS The management of primary small bowel and colon lymphoma is controversial. A review of the literature was therefore undertaken to evaluate the evidence for the classification, staging, diagnosis, and treatment of primary small bowel and colon lymphoma and guide management. METHODS A literature search was performed utilising Embase, Medline, and Pubmed and papers were evaluated on an individual basis. RESULTS Consensus opinion favours the WHO classification scheme and the TNM staging systems for primary small bowel and colon lymphoma. CT enteroclysis and barium enterolysis are recommended for the diagnosis of primary small bowel lymphoma and capsule endoscopy and double-balloon enteroscopy maybe useful diagnostic tools. In terms of the diagnosis and staging of primary colonic lymphoma, the evidence is scarce and CT is to be recommended. The mainstay of treatment for primary GI lymphoma is surgery and/or chemotherapy. For primary small bowel and colonic lymphoma, there was no definitive evidence regarding the benefits of either strategy; however, chemotherapy seemed to give a survival benefit over surgery alone for primary small bowel lymphoma and colonic lymphoma was skewed towards surgery plus chemotherapy due to the large number of patients presenting as an emergency. CONCLUSION Published data regarding the management of primary small bowel and colon lymphoma is very limited. Classification and staging should be standardised to enable accurate evaluation of investigations and treatments and a large RCT undertaken to compare chemotherapy and surgery. Currently, we would recommend that management should involve chemotherapy with surgery reserved for those with clinical indication.
Collapse
|
28
|
Yaprak M, Ozlem Elpek G, Erdogan O. Perianal lymphoma presenting as an abscess in a heterosexual and nonimmunocompromised patient: report of a case. J Gastrointest Cancer 2011; 43:117-20. [PMID: 21360268 DOI: 10.1007/s12029-011-9270-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Muhittin Yaprak
- The Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
| | | | | |
Collapse
|
29
|
Stanojevic GZ, Nestorovic MD, Brankovic BR, Stojanovic MP, Jovanovic MM, Radojkovic MD. Primary colorectal lymphoma: An overview. World J Gastrointest Oncol 2011; 3:14-8. [PMID: 21267399 PMCID: PMC3026053 DOI: 10.4251/wjgo.v3.i1.14] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/20/2010] [Accepted: 12/27/2010] [Indexed: 02/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Goran Z Stanojevic
- Goran Z Stanojevic, Milica D Nestorovic, Branko R Brankovic, Miroslav P Stojanovic, Milan M Jovanovic, Milan D Radojkovic, Clinic for General Surgery, Clinical Center Nis, Bul Zorana Djindjica 48, 18000 Nis, Serbia
| | | | | | | | | | | |
Collapse
|
30
|
Martínez Baena D, Díaz Gómez D, Parra Membrives P, Brox Jiménez A. [Diagnostic value of laparoscopy in peritoneal lymphomatosis]. Cir Esp 2009; 88:202-3. [PMID: 19863952 DOI: 10.1016/j.ciresp.2009.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/06/2009] [Accepted: 07/07/2009] [Indexed: 11/26/2022]
|
31
|
Cheung MC, Housri N, Ogilvie MP, Sola JE, Koniaris LG. Surgery does not adversely affect survival in primary gastrointestinal lymphoma. J Surg Oncol 2009; 100:59-64. [PMID: 19399785 DOI: 10.1002/jso.21298] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the impact of surgery on gastrointestinal lymphoma. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1973 to 2005. RESULTS A total of 17,222 cases of PGIL were identified. The overall incidence of PGIL was approximately 1.505 cases per 100,000. A significantly increasing incidence for PGIL was observed (APC = +4.67, P < 0.05). In the cases for which treatment data was available, resection occurred in roughly half of the patients. In univariate analysis, surgical extirpation did not improve survival (47 months vs. 76 months, P < 0.001), while radiation treatment improved median survival (77 months vs. 59 months, P < 0.001). Multivariate analysis revealed increasing age and male gender as independent predictors of decreased overall survival. Tumor location also was a significant predictor of outcome. Large B-cell lymphoma type PGIL had a poorer prognosis than marginal zone B-cell lymphoma. By multivariate analysis, surgery was not found to increase the risk of death (HR = 0.99). CONCLUSIONS No associated survival benefit for surgery in the treatment in gastrointestinal lymphoma was observed. Determination of lymphoma should preclude surgical resection. Nonetheless, inadvertent extirpative surgery or in association with perforation does not appear to increase mortality.
Collapse
Affiliation(s)
- Michael C Cheung
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | | | | |
Collapse
|
32
|
Abstract
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.
Collapse
|
33
|
Sarkhosh K, Bathe OF, Stewart DA, Mack LA. The role of surgical intervention in the management of duodenal lymphoma. J Surg Oncol 2009; 99:428-32. [PMID: 19347885 DOI: 10.1002/jso.21269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The role of surgical management in duodenal lymphoma is controversial due to the rarity of this tumor subtype. A retrospective review of a provincial cancer registry was performed to assess the rationale for surgical management in duodenal lymphoma. METHODS Patient demographics, presentations, pathologies, surgical interventions, treatment, and associated disease-specific survival were assessed and descriptively presented. RESULTS From 1985 to 2005, 23 patients (mean age 58 years [22-82]) were diagnosed. The most common histology was large B-cell lymphoma (74%). A significant proportion presented in a complicated fashion: obstruction (30%), perforation (17%), and hemorrhage (4%). Eight patients (35%) were treated with surgery alone, eight (35%) with surgery and chemotherapy, five (22%) with chemotherapy alone, and two (9%) with supportive care. Of those treated with surgery, indications were mostly emergent conditions including obstruction (58%), perforation (33%), and hemorrhage (8%). Overall median follow-up was 14 months (1-168 months) and overall median survival was 12 months (1-168 months). There were no significant differences in survival by histology, stage, or treatment type. CONCLUSIONS Chemotherapy continues to represent the therapeutic mainstay for GI lymphomas. However, in duodenal lymphoma, a high proportion of patients require surgery mainly because of complicated presentations.
Collapse
Affiliation(s)
- Kourosh Sarkhosh
- Department of Surgery, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta T2N 4N2, Canada
| | | | | | | |
Collapse
|
34
|
Chen CY, Wu CC, Hsiao CW, Chen CW, Jin JS, Jao SW. Primary non-Hodgkin's lymphoma of rectum presenting with rectal prolapse. J Pediatr Surg 2009; 44:e1-3. [PMID: 19433152 DOI: 10.1016/j.jpedsurg.2009.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 11/26/2022]
Abstract
Involvement of the rectum by primary or secondary malignant lymphoma is uncommon in adults. Primary lymphoma of the rectum in children is an extremely rare occurrence. We describe a 12-year-old boy with a localized rectal tumor that presented with rectal prolapse and bleeding, mimicking a juvenile polyp. He underwent transrectal local wide excision of the tumor, and the pathologic condition proved to be non-Hodgkin's lymphoma of diffuse large B-cell type. This case illustrates the importance of considering the possibility of a rectal malignancy manifesting as a rectal prolapse even in children and the surgical strategy used.
Collapse
Affiliation(s)
- Chao-Yang Chen
- Department of Surgery, Division of Colorectal Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
35
|
Gao BX, Wang L, Wei N. Clinicopathologic features of primary gastrointestinal lymphoma: an analysis of 14 cases. Shijie Huaren Xiaohua Zazhi 2009; 17:610-613. [DOI: 10.11569/wcjd.v17.i6.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the clinicopathologic features of primary gastrointestinal lymphoma (PGIL).
METHODS: Clinical data of 14 cases with pathologically or endoscopically confirmed PGIL at our hospital from January 1994 to March 2008, were retrospectively analyzed.
RESULTS: The study comprised 8 patients with primary gastric lymphoma (PGL group), 5 with primary intestinal lymphoma (PIL group) and 1 with both primary gastric and intestinal lymphoma (mixed group). The main clinical symptom was abdominal pain, and others included emaciation, poor appetite, abdominal mass and anaemia. Two patients were classified as low-grade malignant lymphoma, and 12 patients high-grade lymphoma including 2 diffused large B-cell lymphoma and 10 diffused large B-cell lymphoma plus MALT lymphoma. Nine patients had stage Ⅰ disease, 3 had stageⅡE disease, 2 had stage Ⅲ disease. The average age of patients in the PIL plus mixed group was significantly younger than that in PGL group (49.00 ± 13.05 vs 69.12 ± 7.7, P < 0.01).
CONCLUSION: PGIL has no specific clinical symptoms, but deserves highly attention in clinical practice for its late-stage and high-grade lymphoma incidence and early age of onset in PIL and mixed group lymphoma.
Collapse
|
36
|
Abstract
With a lifetime risk of 1% and 700 new cases per year, Non-Hodgkin lymphoma (NHL) is the seventh most frequent type of cancer in Denmark. The incidence of NHL has increased considerably in Western countries over the last decades; consequently, NHL is an increasing clinical problem. Ophthalmic lymphoma, (lymphoma localized in the ocular region, i.e. eyelid, conjunctiva, lacrimal sac, lacrimal gland, orbit, or intraocularly) is relatively uncommon, accounting for 5%-10% of all extranodal lymphomas. It is, however, the most common orbital malignancy. The purpose of this thesis was to review specimens from all Danish patients with a diagnosis of ophthalmic lymphoma during the period 1980-2005, in order to determine the distribution of lymphoma subtypes, and the incidence- and time trends in incidence for ophthalmic lymphoma. Furthermore, an extended analysis of the most frequent subtype, extranodal marginal zone lymphoma (MALT lymphoma), was done to analyse clinical factors and cytogenetic changes with influence on prognosis. A total of 228 Danish patients with a biopsy-reviewed verified diagnosis of ocular adnexal-, orbital-, or intraocular lymphoma were identified. We found that more than 50% of orbital- and ocular adnexal lymphomas were of the MALT lymphoma subtype, whereas diffuse large B-cell lymphoma (DLBCL) predominated intraocularly (Sjo et al. 2008a). Furthermore, lymphoma arising in the lacrimal sac was surprisingly predominantly DLBCL (Sjo et al. 2006). Incidence rates were highly dependent on patient age. There was an increase in incidence rates for the whole population from 1980 to 2005, corresponding to an annual average increase of 3.4% (Sjo et al. 2008a). MALT lymphoma arising in the ocular region was found in 116 patients (Sjo et al. 2008b). One third of patients had a relapse or progression of disease after initial therapy and relapses were frequently found at extra-ocular sites. Overall survival, however, was not significantly poorer for patients with relapse. Furthermore, we found that the frequency of translocations involving the MALT1- and IGH-gene loci is low in ocular region MALT lymphoma (2 of 42, 5%), but may predict increased risk of relapse (Sjo et al. 2008b). In conclusion the incidence of ophthalmic lymphoma is increasing at a high rate in Denmark. Ophthalmic lymphoma consists primarily of MALT lymphoma. The molecular pathogenesis of MALT lymphoma arising in the ocular region rarely involves translocations in the MALT1- and IGH-gene loci.
Collapse
Affiliation(s)
- Lene Dissing Sjö
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
37
|
Non-Hodgkin's lymphomas of the large bowel-clinical characteristics, prognostic factors and survival. ACTA ACUST UNITED AC 2009; 55:109-14. [PMID: 19069702 DOI: 10.2298/aci0803109s] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aims of this study were to review the clinical presentation of non-Hodgkin's lymphomas of the large bowel, to analyze the prognostic factors using univariate and multivariate methods, as well as the overall survival. We identified 24 cases at our clinic between 1991 and 2005, based on pathohistological analysis and standard diagnostic criteria established by Dawson et al. They accounted for 1.2% of all cases of the large bowel malignancies (24/2021) during this period. The following clinical information such as age, gender, symptoms, tumor localization, operation performed, histology grade, stage of disease, and adjuvant chemotherapy was obtained. Survival function was expressed by Kaplan-Meier curve and Log-rank test was performed for the difference in survival between two patient groups. Multivariate analysis was carried out using the Cox proportional hazard model. Overall mean survival time was 41.91 months. According to the univariete analysis, the factors influencing overall survival rate was operation type (elective and emergent). Tumor stage and operation type were independent prognostic factors for survival, as determined by multivariate analysis. Our results showed that tumor stage and operation type should be considered as the most important prognostic factors in patients with primary non-Hodgkin's lymphomas of the large bowel.
Collapse
|
38
|
Affiliation(s)
- Ahmed N. Assar
- General Surgery, Luton and Dunstable Hospital, Lewsey Road, Luton-LU4 0DZ, Bedfordshire - United Kingdom. E-mail:
| |
Collapse
|
39
|
Adenocarcinoma and Other Small Intestinal Malignancies. Oncology 2007. [DOI: 10.1007/0-387-31056-8_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
40
|
Abstract
We conducted a retrospective tumor registry review of a 36-year experience in a university center and identified 10 patients with duodenal lymphoma (five localized, five disseminated). Histologic types included diffuse large B-cell in four patients, mucosa-associated lymphoid tumor in three, and Hodgkin, follicular, and unclassified (one each). Treatments included chemotherapy in four patients, radiation therapy (RT) in two patients, Helicobacter pylori treatment in two, and observation in one. Five patients underwent operations (emergent in two, elective in three) for indications including massive bleeding in two patients, obstruction in two, or both in one. Survival for surgical group was 25 per cent at 1 year. One-year survival for nonsurgical group was 100 per cent, and all nonoperated patients lived at least 5 years, except for one who is alive 2 years after diagnosis. Surgical patients were younger and had more advanced lesions and less favorable cell types. When operation is required for bleeding or obstruction from secondary tumors in younger patients with disseminated disease, surgical challenges are formidable and survival is very limited. Tumors of less aggressive histology have far better prognosis.
Collapse
Affiliation(s)
- Paul J. Chestovich
- Division of General Surgery, Department of Surgery, the, Los Angeles, California
| | - Gary Schiller
- Division of Hematology–Oncology, Department of Medicine, and the, Los Angeles, California
| | - Sebastian Sasu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan R. Hiatt
- Division of General Surgery, Department of Surgery, the, Los Angeles, California
| |
Collapse
|
41
|
Gutierrez JC, De Oliveira LOP, Perez EA, Rocha-Lima C, Livingstone AS, Koniaris LG. Optimizing diagnosis, staging, and management of gastrointestinal stromal tumors. J Am Coll Surg 2007; 205:479-91 (Quiz 524). [PMID: 17765165 DOI: 10.1016/j.jamcollsurg.2007.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 01/22/2007] [Accepted: 04/02/2007] [Indexed: 01/22/2023]
Affiliation(s)
- Juan C Gutierrez
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
| | | | | | | | | | | |
Collapse
|
42
|
Cai S, Cannizzo F, Bullard Dunn KM, Gibbs JF, Czuczman M, Rajput A. The role of surgical intervention in non-Hodgkin's lymphoma of the colon and rectum. Am J Surg 2007; 193:409-12; discussion 412. [PMID: 17320545 DOI: 10.1016/j.amjsurg.2006.12.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 09/10/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gastrointestinal involvement of non-Hodgkin's lymphoma (NHL), although rare, may require surgical intervention. The purpose of the current study was to determine the incidence, presentation, and management of patients with NHL of the colon or rectum. METHODS Demographic data, signs, symptoms, disease stage, and treatment of patients with a primary gastrointestinal lymphoma treated between 1973 and 2005 were identified. RESULTS Forty-three of 244 gastrointestinal lymphoma patients (18%) had colon or rectal involvement. Most common symptoms on presentation were pain (49%), hematochezia (49%), change in bowel habits (23%), and weight loss (19%). Most common site of involvement was the ileocecum. Twenty-six patients (60%) required surgery. The majority (56%) had urgent or emergent operations. CONCLUSIONS Colorectal involvement by NHL occurred in 18% of patients with gastrointestinal lymphoma. Surgery was required for pain, obstruction, and/or bleeding. Physicians caring for patients must be aware of the potential need for surgery in treating this patient population.
Collapse
Affiliation(s)
- Steven Cai
- Department of Surgery, The State University of New York at Buffalo, Buffalo, NY, USA
| | | | | | | | | | | |
Collapse
|
43
|
Kamona AA, El-Khatib MA, Swaidan MY, Jarar MS, Suleiman AJ, Ali HMA, Basharaheel AB, Mansour AH. Pediatric Burkitt's lymphoma: CT findings. ACTA ACUST UNITED AC 2006; 32:381-6. [PMID: 16933114 DOI: 10.1007/s00261-006-9069-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 07/06/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To review and analyze all CT scans of the cases of Burkitt's lymphoma (BL) in children diagnosed in our institution. MATERIALS AND METHODS A retrospective analysis of 33 children with BL between the years 2003 and 2005 seen in our institution was undertaken. Twenty-nine male and four female patients from age 3 to 16 years (with a mean age 5.9 years) were reviewed. RESULTS The gastrointestinal tract was involved in 19 patients (57.5%), kidneys in 9 (27.2%), peritoneum in 8 (24.2%), liver in 4 (12.1%), spleen in 3 (9%), adrenals in 3 (9%), and pancreas in 1 patient (3%). Extra-nodal head and neck involvement was seen in eight patients (24.2%). Bone involvement in four (12.1%), lung in three (9%), heart in two (6%), skin in two (6%), and testis in one (3%) of these patients. Abdominal lymph nodes were enlarged in 21 children (63.6%), while cervical lymph nodes were enlarged in 8 (24.2%). CONCLUSION CT proved to be an invaluable tool in the characterization of the disease processes in these children. In addition, it provided us with useful information about the anatomical distribution, patterns of involvement, as well as complications of BL.
Collapse
Affiliation(s)
- Atheel A Kamona
- Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Primary tumors of jejunum and ileum as a cause of intestinal obstruction: a case control study. Int J Surg 2006; 5:183-91. [PMID: 17509501 DOI: 10.1016/j.ijsu.2006.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 05/08/2006] [Accepted: 05/10/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Small-bowel tumors are rare and account for 1-2% of all gastrointestinal neoplasms. Most of these tumors are found at surgery indicated for other diagnosis or intestinal obstruction. The rarity, unclear presentation and diagnostic difficulty of these tumors stimulated our interest to review our experience with emergency surgery for intestinal obstruction secondary to jejunoileal tumors. METHODS We reviewed 17 patients operated on for intestinal obstruction secondary to benign and malignant primary tumors of jejunum and ileum at our institution the last 10 years. RESULTS The series comprised 8 male and 9 female patients, most of them younger than 49 years of age. The most frequent tumors found were GIST (36%) followed by lymphomas (24%) and adenocarcinomas (18%). Most tumors (65%) were located in the ileum. Mean survival for patients with malignant tumors was 19.5+/-13 months, and for patients with benign tumors 72+/-20 months (p<0.05). CONCLUSION Jejunoileal tumors present frequently in patients younger than 49 years of age. Ileal tumors are more likely to develop intestinal obstruction than jejunal tumors. Emergency surgery for these patients precludes a complete and negative margin resection and constitutes a risk factor for residual disease and short-term survival.
Collapse
|