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Hernandez Dominguez O, Lincango EP, Spivak R, Almonacid-Cardenas F, Prien C, Uchino T, Spivak A, Hull TL, Steele SR, Holubar SD. Colosplenic fistula diagnosis and management: a case series and review of literature. Int J Surg 2024; 110:2381-2388. [PMID: 38668664 PMCID: PMC11020030 DOI: 10.1097/js9.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered. METHODS A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected. RESULTS Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality. CONCLUSIONS Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.
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Affiliation(s)
| | - Eddy P. Lincango
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Rebecca Spivak
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | | | - Christopher Prien
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Tairin Uchino
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Anna Spivak
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Tracy L. Hull
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Scott R. Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Stefan D. Holubar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
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Saraiva S, Bernardo S, Fernandes S, Costa P, Correia L, Tato Marinho R. Primary Diffuse Large B-Cell Lymphoma of the Rectum in a Non-Immunosuppressed Patient with Ulcerative Colitis. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:305-310. [PMID: 37767308 PMCID: PMC10521321 DOI: 10.1159/000522044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 09/29/2023]
Abstract
Introduction The incidence of primary colorectal lymphoma in the gastrointestinal tract is very low, the rectum being infrequently affected. The development of this entity in inflammatory bowel disease patients usually occurs in a context of immunosuppression-based therapy, with only a few case reports describing its development in patients presenting no known risk factors. Moreover, the clinical presentation of primary colorectal lymphomas may be difficult to distinguish from an acute flare of ulcerative colitis (UC). Case Presentation We present a case of non-Hodgkin lymphoma of the rectum in a 42-year-old male with a 7-year history of UC and no previous exposure to immunomodulatory agents. He presented with a history of mucous diarrhoea, tenesmus, proctalgia and weight loss, refractory to optimized therapy. A lower gastrointestinal endoscopy was performed revealing a circumferential ulcerated lesion of the rectum, from which histopathological analysis established the diagnosis of a non-Hodgkin diffuse large B-cell lymphoma (DLBCL). Discussion/Conclusion The present case suggests the existence of alternative mechanisms for the development of DLBCL in UC patients. The clinical presentation mimicking an acute flare of UC posed a diagnostic challenge, highlighting the complexity behind the management of UC patients.
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Affiliation(s)
- Sofia Saraiva
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Sónia Bernardo
- Gastroenterology and Hepatology Department, Centro Hospital Universitário de Lisboa Norte − Hospital de Santa Maria, Lisbon, Portugal
| | - Samuel Fernandes
- Gastroenterology and Hepatology Department, Centro Hospital Universitário de Lisboa Norte − Hospital de Santa Maria, Lisbon, Portugal
| | - Pedro Costa
- Gastroenterology and Hepatology Department, Centro Hospital Universitário de Lisboa Norte − Hospital de Santa Maria, Lisbon, Portugal
| | - Luis Correia
- Gastroenterology and Hepatology Department, Centro Hospital Universitário de Lisboa Norte − Hospital de Santa Maria, Lisbon, Portugal
| | - Rui Tato Marinho
- Gastroenterology and Hepatology Department, Centro Hospital Universitário de Lisboa Norte − Hospital de Santa Maria, Lisbon, Portugal
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3
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Okoye C, Tran M, Soladoye E, Akahara DE, Emeasoba CM, Ojinna BT, Anasonye E, Obadare OO, Diala CS, Salaudeen BH, Evbayekha EO, Okobi OE. A Review of 10-Year Survivability of Immunotherapy in the Management of Colon Cancer. Cureus 2023; 15:e43189. [PMID: 37692610 PMCID: PMC10485874 DOI: 10.7759/cureus.43189] [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: 06/30/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Colon cancer is one of the most common cancers in the United States of America. In addition to conventional treatment approaches such as surgery, chemotherapy, and radiation for colorectal cancer, immunotherapy has gained recognition over the past few years. However, its effectiveness in colorectal cancer treatment is controversial. Our study investigates the survival and progression-free rates of immunotherapy for different types of colorectal cancer over the last 10 years. We conducted literature reviews from various clinical trials and research studies to evaluate immunotherapy's role in colorectal cancer treatment. We also investigated how it affects clinical outcomes. We discovered a range of effective immunotherapy approaches targeting various growth factors and signaling pathways. These modalities include monoclonal antibodies aimed at growth factors such as epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), human epidermal growth factor receptor 2 (HER2), and downstream signaling pathways such as mitogen-activated protein kinase (MAPK), kirsten rat sarcoma viral oncogene (KRAS), B-raf proto-oncogene, serine/threonine kinase (BRAF), and phosphatase and tensin homolog (PTEN). Additionally, we identified immune checkpoint inhibitors, such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitors and programmed cell death ligand 1 (PD-L1) inhibitors, as well as target therapy and adoptive cell therapy as promising immunotherapeutic options. Nevertheless, the application of immunotherapy remains highly limited due to various factors influencing survival and progression-free rates, including tumor microenvironment, microsatellite instability, immune checkpoint expression, and gut microbiome. Additionally, its effectiveness is restricted to a small subgroup of patients, accompanied by side effects and the development of drug resistance mechanisms. To unlock its full potential, further clinical trials and research on molecular pathways in colorectal cancer are imperative. This will ultimately enhance drug discovery success and lead to more effective clinical management approaches.
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Affiliation(s)
- Chiugo Okoye
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - My Tran
- Internal Medicine, Baptist Health-University of Arkansas for Medical Sciences - Arkansas, North Little Rock, USA
| | | | | | | | - Blessing T Ojinna
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | | | - Chiamaka S Diala
- Health/Biomedical Informatics, The University of Texas Health Science Center, Houston, USA
- Internal Medicine, Piedmont Athens Regional, Athens, USA
| | | | | | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
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4
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Kiamos A, Streit SG, Karan A, Boldig K, Attarha BO, Kahn Z, Omman R, Schey R, Gharia B. Unusual Instance of Primary Diffuse Large B-cell Lymphoma of the Colon. Cureus 2023; 15:e36083. [PMID: 37065294 PMCID: PMC10095599 DOI: 10.7759/cureus.36083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/14/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) commonly affects the gastrointestinal (GI) tract, although primary DLBCL rarely occurs in the colon. Primary colorectal lymphoma is a surprisingly rare diagnosis, accounting for a minute percentage of GI lymphomas and colorectal malignancies. We present an interesting case of an immunocompromised young adult female who was diagnosed with DLBCL confined to a cecum polyp after she underwent a colonoscopy for a GI bleed. The lymphoma presented endoscopically as a semi-sessile polyp in the cecum that was successfully removed. The patient was treated with appropriate therapy of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
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5
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Diffuse Large B-Cell Lymphoma of the Cecum. ACG Case Rep J 2023; 10:e01004. [PMID: 36891185 PMCID: PMC9988278 DOI: 10.14309/crj.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
Lymphoma when arising from sites other than lymph nodes is termed extranodal lymphoma, commonly affecting the gastrointestinal tract. Primary colorectal lymphoma is a rare phenomenon among malignancies affecting the colon. We report a case of a patient with a history of Burkitt lymphoma in remission, presenting with a large cecal mass and a new diagnosis of diffuse large B-cell lymphoma treated with chemotherapy.
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6
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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.
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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.
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7
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Tao Y, Nan Q, Lei Z, Miao YL, Niu JK. Rare primary rectal mucosa-associated lymphoid tissue lymphoma with curative resection by endoscopic submucosal dissection: A case report and review of literature. World J Clin Cases 2022; 10:7599-7608. [PMID: 36158004 PMCID: PMC9353914 DOI: 10.12998/wjcc.v10.i21.7599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/19/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurs in approximately 9% of non-Hodgkin B-cell lymphomas. The gastrointestinal tract is the most commonly affected site of the extranodal forms of primary non-Hodgkin’s lymphomas. However, it rarely occurs within the rectum, and at present, there is no consensus on its diagnosis and treatment at this site.
CASE SUMMARY We report a rare laterally spreading tumour-like rectal MALT lymphoma case in which the diagnosis and the depth of infiltration were determined by magnifying endoscopy and ultrasonic endoscopy. Then, the lesion was en bloc resected by endoscopic submucosal dissection (ESD) alone. The lesion was confirmed as MALT lymphoma by haematoxylin and eosin staining, immunohistochemical staining and gene arrangement analysis. Surveillance exams have indicated a 2-year disease-free survival for this patient.
CONCLUSION We report a rare primary rectal MALT lymphoma that was curable with resection by ESD. ESD is a safe and effective therapeutic option for rectal MALT lymphoma.
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Affiliation(s)
- Yan Tao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Zi Lei
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Ying-Lei Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Jun-Kun Niu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
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8
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Analysis of 78 Cases of Primary Gastrointestinal Lymphoma. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3414302. [PMID: 35345653 PMCID: PMC8957407 DOI: 10.1155/2022/3414302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 01/08/2023]
Abstract
This paper studied the pathological features of 78 cases of primary gastrointestinal lymphoma. All patients with primary gastrointestinal lymphoma diagnosed in PET Center of Zhebei Mingzhou Hospital in Huzhou from August 2013 to April 2021 were analyzed retrospectively. In addition, the pathology and immunohistochemistry of these patients were retrieved from the inpatient system of Huzhou Central Hospital. The results showed that the male-female ratio of these 78 patients was about 1.29/1 (including 44 males and 34 females), with a median age of 63 years old (20–90 years old). The most frequent sites in order of its occurrence were the stomach (51.3%), small intestine (34.6%), ileocecal region (9%) and colon (5.1%). T-cell lymphoma accounted for 10.7% of primary gastrointestinal lymphoma, and all of them were found in small intestines, while B-cell lymphoma accounted for 89.3%.
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9
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Nakrani R, Yeung HM, Arnon M, Selby A, Burgert-Lon C, Kamat B. An unusual presentation of non-IBD related colorectal primary extranodal diffuse large B cell lymphoma with a colo-colonic fistula. J Community Hosp Intern Med Perspect 2021; 11:662-666. [PMID: 34567459 PMCID: PMC8462868 DOI: 10.1080/20009666.2021.1951946] [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] [Indexed: 11/13/2022] Open
Abstract
Diffuse large B cell lymphoma of the sigmoid colon and rectum is relatively uncommon and aggressive. Due to its nonspecific symptomatology, patients are often diagnosed late into the disease and present with life-threatening complications, such as hemorrhage, obstruction, or perforation, requiring emergent surgical intervention. Patients with colorectal lymphoma typically have inflammatory bowel disease or immunosuppression. We present a case of a 79-year-old male with no known inflammatory bowel disease or immunosuppression, who had significant weight loss, diarrhea, and abdominal fullness, found by CT to have irregular wall thickening of the recto-sigmoid colon along with a colo-colonic fistula, concerning for bowel perforation. Endoscopic evaluation and biopsy confirmed the diagnosis of recto-sigmoid Diffuse large B cell lymphoma, with a PET/CT scan revealing stage IV disease. He had a partial response to six cycles of palliative reduced dose R-CHOP and is currently receiving palliative radiation to the sigmoid colon and rectum. Surgery and/or chemoradiation remain the mainstay therapy for this condition. Clinicians, however, must consider patient’s functional, nutritional, and clinical status prior to choosing an optimal therapeutic regimen. This case illustrates a unique clinical presentation of this condition and the associated diagnostic and therapeutic challenges that arise in order to prevent life-threatening complications.
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Affiliation(s)
- Rima Nakrani
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Ho-Man Yeung
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Matan Arnon
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Alexandra Selby
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | | | - Bhishak Kamat
- Department of Radiology, Temple University Hospital, Philadelphia, PA, USA
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10
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Clinical and pathological characterization of colon lymphomas. Dig Liver Dis 2021; 53:672-674. [PMID: 33509739 DOI: 10.1016/j.dld.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022]
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11
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Konstantinidou S, Cosgrove C, Campbell W. FOLLICULAR LYMPHOMA OF THE RECTUM. THE ULSTER MEDICAL JOURNAL 2020; 89:125-126. [PMID: 33093703 PMCID: PMC7576384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Conley TE, Andrews T, Arumainathan A, O'Toole P, Smith PJ, Subramanian S. An unexpected cause of iron deficiency. Gut 2020; 70:gutjnl-2020-321830. [PMID: 32546471 DOI: 10.1136/gutjnl-2020-321830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Thomas Edward Conley
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Timothy Andrews
- Histopathology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | | | - Paul O'Toole
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Philip J Smith
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Sreedhar Subramanian
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
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13
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Hollie N, Asakrah S. MALT lymphoma of the colon: a clinicopathological review. J Clin Pathol 2020; 73:378-383. [PMID: 32034054 DOI: 10.1136/jclinpath-2019-206377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/06/2023]
Abstract
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurs in approximately 9% of non-Hodgkin B cell lymphoma. However, it occurs only rarely within the colon. The presentation is often asymptomatic, and can have multiple endoscopic appearances, including a single or multinodular polypoid lesion. Furthermore, small biopsies can make histological evaluation challenging. The 2016 WHO classification update includes many molecular features of entities and expands the differential diagnosis of lymphoid lesions of the colon. In addition to immunohistochemistry, molecular methods may be tempting to use for small difficult cases. Furthermore, treatment approaches are varied for this entity, and not well studied. Therefore, an updated review on MALT lymphoma of the colon is needed.
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Affiliation(s)
- Norris Hollie
- Pathology, Beth Israel Lahey Health, Boston, Massachusetts, USA
| | - Saja Asakrah
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
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14
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Xu T, Wang L, Zhou L, Wang Z, Zhu Y, Ju F. Primary colorectal diffuse large B-cell lymphoma initially presenting with pleural effusion: report of one case and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:254-260. [PMID: 32211106 PMCID: PMC7061804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
Gastrointestinal (GI) diffuse large B-cell lymphoma (DLBCL) is one of the frequently reported histologic subtypes of non-Hodgkin lymphoma (NHL) that occur in the GI tract. However, the presentation of quite different clinical manifestations, morphologic characteristics, immunophenotypes, and molecular biologic features is challenging for its diagnosis. Herein, we describe a rare case of primary colorectal DLBCL that occurred in a 59-year-old immunocompetent Chinese female who attended our respiratory clinic for the third time with an asymptomatic pleural effusion and pleural thickening. In her clinical setting, there was no history of trauma or travel, and no evidence of infections, connective tissue diseases, or malignancies such as pleural mesothelioma. Lymphoma was highly suspected for the enlargement of systemic lymph nodes and the multiple polypoid appearance in the rectum found by endoscopy examination. In a repeated colonoscopy, immunohistochemical and molecular features of the multiple "polyps" allowed diagnosis of colorectal diffuse large B-cell NHL. To our knowledge, this is the first case of a verified diagnosis of pleural effusion associated with a primary colorectal DLBCL. The purpose of this report is to alert clinicians that when we evaluate the causes of unexplained pleural effusion, lymphoma should be considered, particularly when the available examination data cannot be corroborated by clinical manifestations.
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Affiliation(s)
- Tingzhen Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medicine University Hangzhou, Zhejiang, P. R. China
| | - Lu Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medicine University Hangzhou, Zhejiang, P. R. China
| | - Linshui Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medicine University Hangzhou, Zhejiang, P. R. China
| | - Zhen Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medicine University Hangzhou, Zhejiang, P. R. China
| | - Yuanhong Zhu
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medicine University Hangzhou, Zhejiang, P. R. China
| | - Fanghe Ju
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medicine University Hangzhou, Zhejiang, P. R. China
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15
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Successful Endoscopic Resection of Mucosa-Associated Lymphoid Tissue Lymphoma of the Colon. ACG Case Rep J 2019; 6:e00228. [PMID: 31832456 PMCID: PMC6855546 DOI: 10.14309/crj.0000000000000228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/28/2019] [Indexed: 12/17/2022] Open
Abstract
Mucosa-associated lymphoid tissue lymphomas are the most common form of primary malignant gastrointestinal lymphoma. Although typically found in the stomach, extragastric locations have been described, in rare cases, the colon. The optimal management of these neoplasms remains uncertain and limited largely to small retrospective series or case reports. We report a patient with a colonic mucosa-associated lymphoid tissue lymphoma identified during a routine screening colonoscopy which was removed endoscopically without any adjuvant antimicrobial therapy, chemotherapy, or radiation therapy. She remained disease-free after the 1-year follow-up, providing support to potential endoscopic therapy in appropriately selected patients.
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16
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Li M, Zhang L, Liang X, Huang WT, Ma JW, Wan Y, Wu N. Primary colorectal lymphoma: computed tomography and double-contrast barium enema examination findings with histopathological correlation in 19 patients. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:308. [PMID: 31475178 DOI: 10.21037/atm.2019.06.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Primary colorectal lymphoma (PCL) is a rare disorder, the accurate imaging diagnosis of which remains a clinical challenge. This study aimed to characterize the imaging features of PCL by double-contrast barium enema (DCBE) examination and computed tomography (CT) and correlate them with histopathological findings. Methods DCBE (n=6) and CT (n=19) findings for 19 pathologically proven PCLs were evaluated and compared with histopathological findings in this retrospective analysis. Results Non-Hodgkin lymphoma was present in all patients, and the most common histological type was diffuse large B-cell lymphoma (63.2%, 12/19). The most common site was the ileocecum (84.2%, 16/19). CT revealed circumferential infiltrative lesions (68.4%, 13/19), polypoid masses (26.3%, 5/19) and ulcerative lesions (5.3%, 1/19). Most (94.7%, 18/19) lesions appeared as moderate enhancements. Fourteen (73.7%, 14/19) patients had serous membrane infiltration presenting as a poorly defined serous membrane and focal opacities in the pericolonic fat. Regional lymph node involvement was observed in twelve (63.2%, 12/19) patients who presented with aggregated nodules or masses. Frequent findings of the DCBE exam included a filling defect and niche with slight mucosal destruction, mild luminal narrowing and preserved peristalsis. The imaging appearance reflected the gross pathological findings well, although the preoperative diagnostic accuracy was low. Conclusions The imaging features of PCL have a relatively characteristic appearance but are still, at times, hardly differentiated from carcinoma. Familiarity with the radiological features of PCL on DCBE and CT can help ensure a correct diagnosis.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xin Liang
- Medical Statistics Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wen-Ting Huang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jing-Wen Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuan Wan
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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