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Hiyama K, Terashima H, Nakano Y, Kamiga M, Harada K, Horiguchi H, Mamiya T. Primary rectal diffuse large B-cell lymphoma associated with ulcerative colitis: a case report. Clin Case Rep 2014; 3:150-5. [PMID: 25838903 PMCID: PMC4377245 DOI: 10.1002/ccr3.185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/19/2014] [Accepted: 10/25/2014] [Indexed: 01/12/2023] Open
Abstract
We need to be aware of primary intestinal lymphoproliferative disease (PILD) associated with ulcerative colitis (UC). We should carefully monitor UC patients, particularly patients who meet the following conditions; a previous Epstein-Barr virus infection, treatment duration ≧4 years, male, and age ≧50 years.
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Affiliation(s)
- Kazuhiro Hiyama
- Department of Surgery, Hitachi Ltd. Hitachinaka General Hospital Hitachinaka, Ibaraki, Japan
| | - Hideo Terashima
- Hitachinaka Medical Education and Research Center, University of Tsukuba Hospital Hitachinaka, Ibaraki, Japan
| | - Yoritaka Nakano
- Department of Surgery, Hitachi Ltd. Hitachinaka General Hospital Hitachinaka, Ibaraki, Japan
| | - Masahiro Kamiga
- Department of Surgery, Hitachi Ltd. Hitachinaka General Hospital Hitachinaka, Ibaraki, Japan
| | - Kyoichi Harada
- Department of Hematology, Hitachi Ltd. Hitachinaka General Hospital Hitachinaka, Ibaraki, Japan
| | - Hisashi Horiguchi
- Department of Pathology, Hitachi Ltd. Hitachinaka General Hospital Hitachinaka, Ibaraki, Japan
| | - Takashi Mamiya
- Hitachinaka Medical Education and Research Center, University of Tsukuba Hospital Hitachinaka, Ibaraki, Japan
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2
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Khan A, Lloyd GM, Ihedioha U, Hemingway D. Rectovesical fistula secondary to B-cell lymphoma of the rectum: a unique presentation of a rare disease. Colorectal Dis 2012; 14:e358-9. [PMID: 22022922 DOI: 10.1111/j.1463-1318.2011.02868.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- A Khan
- Department of Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
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3
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Nishigami T, Kataoka TR, Torii I, Sato A, Tamura K, Hirano H, Hida N, Ikeuchi H, Tsujimura T. Concomitant adenocarcinoma and colonic non-Hodgkin's lymphoma in a patient with ulcerative colitis: a case report and molecular analysis. Pathol Res Pract 2010; 206:846-50. [PMID: 20846793 DOI: 10.1016/j.prp.2010.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 05/01/2010] [Accepted: 07/09/2010] [Indexed: 11/30/2022]
Abstract
Ulcerative colitis (UC) complicated by colonic lymphoma is rare, although UC is often accompanied by adenocarcinoma of the colon. A concurrent existence of adenocarcinoma and lymphoma in a patient with UC is extremely rare, and has not yet been analyzed at the molecular level. We report a 64-year-old female patient with concomitant adenocarcinoma and diffuse large B-cell lymphoma (DLBCL) in the colon of UC. The genetic changes in these two neoplasms were analyzed. The colon adenocarcinomas had a mutation in MSH6 gene, DNA methylation in CDKN2A gene, and increased microsatellite instability (MSI), although these genetic changes were not recognized in either DLBCL or non-neoplastic UC mucosa. The DLBCL was diagnosed as primary colonic lymphoma, and confirmed Epstein-Barr virus (EBV) infection. The adenocarcinomas and the non-neoplastic UC mucosa were EBV-negative. Our case presented here clearly shows that the development of adenocarcinoma and lymphoma in the colon with UC was caused by individual mechanisms.
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Affiliation(s)
- Takashi Nishigami
- Department of Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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4
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Ismaili N, Bensouda Y, Mellas N, Errihani H. Role of chemotherapy in the management of primary rectal lymphoma: a case report and review of the literature. CASES JOURNAL 2009; 2:9373. [PMID: 20062547 PMCID: PMC2804016 DOI: 10.1186/1757-1626-2-9373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 12/22/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Primary rectal lymphoma is a rare disease. In this paper we present an unusual case of primary rectal lymphoma which was managed with chemotherapy and discussed by a thorough review of the related literature. CASES PRESENTATION An 85-years-male patient was diagnosed in Sidi Mohammed Ben Abdellah Hospital as having diffuse large B-cell lymphoma of the rectum at a bulky stage two. This patient was managed successfully with 8 treatment cycles of Cyclophosphamide 750 mg/m2 at day 1 of each cycle, Doxorubicin (50 mg/m2 in the first 4 cycles and 25 mg/m2 in the subsequent cycles) at day 1 of each cycle, Vincristine 1.4 mg/m(2 )at day 1 of each cycle, and prednisone 50 mg/m(2 )at day 1 to 5 of each cycle. CONCLUSION The optimal treatment of primary rectal lymphoma needs more research studying to be achieved.
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Affiliation(s)
- Nabil Ismaili
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
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5
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Guney N, Basaran M, Aksakalli N, Bavbek S, Erseven G. Primary Non-Hodgkin’s Lymphoma of the Rectum. Oncol Res Treat 2007; 30:385-7. [PMID: 17596749 DOI: 10.1159/000103590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary rectal lymphoma is a very uncommon disease, therefore, it has received little attention in the literature. Because of their rarity, rectal lymphomas are generally included in the group of large intestine lymphomas. CASE REPORT We report here a case of primary rectal B-cell lymphoma in a 67-year-old woman. The tumor was originally located in the rectum without evidence of any other lymphoma-involved organ. Histological findings revealed diffuse large B-cell lymphoma. The clinical stage was IE according to the Ann Arbor system. International prognostic index (IPI) was I (low-intermediate risk). We preferred a non-surgical, organ-sparing treatment which started with chemotherapy followed by radiation. 12 months after the end of therapy, there is no sign of tumor recurrence in our patient. CONCLUSION We suggest that histology-specific multidrug chemotherapy followed by radiotherapy seems to be a therapeutic approach that is appropriate fort this rare tumor.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Combined Modality Therapy
- Dose Fractionation, Radiation
- Drug Administration Schedule
- Female
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Rectal Neoplasms/diagnosis
- Rectal Neoplasms/drug therapy
- Rectal Neoplasms/pathology
- Rectal Neoplasms/radiotherapy
- Rectum/pathology
- Sigmoidoscopy
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Affiliation(s)
- Nese Guney
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Turkey
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6
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Kang H, O'Connell JB, Leonardi MJ, Maggard MA, McGory ML, Ko CY. Rare tumors of the colon and rectum: a national review. Int J Colorectal Dis 2007; 22:183-9. [PMID: 16845516 DOI: 10.1007/s00384-006-0145-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Most literature available on rare colorectal cancer (CRC) is from case series reports. This population-based evaluation is the first comprehensive look at four rare histologic types of CRC, allowing comparisons with the more common adenocarcinoma for clinical and pathological features and survival rates. MATERIALS AND METHODS All patients diagnosed with carcinoid (n=2,565), malignant lymphoma (n=955), non-carcinoid neuroendocrine (n=455), squamous cell (n=437), and adenocarcinoma (n=164,638) in SEER cancer database (1991-2000) were analyzed. Evaluation of age-adjusted incidence rate, stage at presentation, and 5-year relative survival were determined for each histologic subtype. RESULTS All rare histologic subtypes had younger mean age than adenocarcinomas (70 years; p<0.05). Lymphoma was more common in males (65.1%; P<0.01). Incidence rates in 2000 per million were: carcinoid 10.6, lymphoma 3.5, neuroendocrine 2.0, squamous 1.9, and adenocarcinoma 496.3. The annual percent change in incidence for each rare tumor increased significantly during the 10 years (range: 3.1-9.4%, p<0.05), except squamous cell carcinoma (5.9%, p>0.05). Squamous (93.4%) and carcinoid (73.7%) tumors occurred more often in the rectum; lymphoma (79.0%), neuroendocrine (70.8%), and adenocarcinoma (70.1%) occurred more often in the colon (P<0.01). Carcinoids presented at earlier stage (localized/regional, 90.5%) more often than adenocarcinoma (80.6%; p<0.01), but squamous cell (82.1%; p=0.50), lymphoma(70.6%; p<0.01), and neuroendocrine (37.8%; p<0.01) presented at earlier stage similarly or less often than adenocarcinoma. Relative 5-year survival rate was highest for carcinoid (91.3%), and lowest for neuroendocrine tumors (21.4%). CONCLUSION This study provides the first population-based analysis of the epidemiology, tumor characteristics, and survival rates for rare CRC.
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Affiliation(s)
- Hakjung Kang
- Department of Surgery, Daehang Hospital, Seoul, South Korea
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7
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Yamamoto R, Kato S, Shimazaki K, Yoshizumi T, Uefuji K, Seo M, Matsuura T, Kikuchi M, Itoh K, Miura S. A case of primary rectal mucosa-associated lymphoid tissue lymphoma treated by endoscopic mucosal resection. Dig Endosc 2005. [DOI: 10.1111/j.1443-1661.2005.00487.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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8
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Myung SJ, Joo KR, Yang SK, Jung HY, Chang HS, Lee HJ, Hong WS, Kim JH, Min YI, Kim HC, Yu CS, Kim JC, Kim JS. Clinicopathologic features of ileocolonic malignant lymphoma: analysis according to colonoscopic classification. Gastrointest Endosc 2003; 57:343-7. [PMID: 12612513 DOI: 10.1067/mge.2003.135] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aims of this study were to classify primary ileocolonic lymphomas according to colonoscopic findings and to determine the clinicopathologic relationship according to classes. METHODS Thirty-two patients (22 men, 10 women; age range 29 to 75 years) with primary malignant lymphoma of the terminal ileum and/or colorectum were studied. The clinicopathologic features were evaluated according to colonoscopic findings. RESULTS Thirty-six lesions in 32 patients were endoscopically classified as follows: fungating (14, 39%), ulcerofungating (11, 31%), infiltrative (5, 14%), ulceroinfiltrative (4, 11%), and ulcerative (2, 6%). Location of the lesions was as follows: terminal ileum, 15 (42%); colorectum, 14 (39%); both regions, 7 (19%). The most common histopathologic types were diffuse large cell (22, 69%) and large cell immunoblastic (5, 16%). There was no relationship between the endoscopic findings and histologic types. In 9 patients (28%), the clinical manifestation was intussusception, and all were found endoscopically to have the fungating type lesion. CONCLUSIONS Primary ileocolonic lymphomas can be classified endoscopically into fungating, ulcerative, infiltrative, ulcerofungating, and ulceroinfiltrative types. Among these, fungating and ulcerofungating are the most frequent. Intussusception is a common clinical finding in ileocolonic lymphomas, occurring mainly in patients with the fungating type of lesion.
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Affiliation(s)
- Seung-Jae Myung
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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9
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Abstract
PURPOSE The purpose of this study was to review the clinical presentation and characteristics of primary colorectal lymphoma, analyze the prognostic factors, and assess the results of treatment with adjuvant chemotherapy. METHODS We identified 37 cases at our institution between 1980 and 1996. They comprised 0.48 percent of all cases of colon malignancies (37/7,658) during this period. The following clinical information was obtained: age, gender, signs and symptoms, tumor site, tumor size, histology grade, pathology, and adjuvant chemotherapy. RESULTS The most common presenting signs and symptoms were abdominal pain (62 percent), abdominal mass (54 percent), and weight loss (43 percent). The most frequent site of involvement was the cecum (45 percent). Histologically, 29 (78 percent) were classified as high-grade, and 8 (22 percent) as intermediate-grade-to-low-grade lymphoma. Nine (24.3 percent) of the cases were Stage EI, 23 (62.2 percent) were Stage EII, and 5 (13.5 percent) were Stage EIV. Twenty-one (57 percent) cases received adjuvant chemotherapy. The five-year survival rate was 33 percent for all patients and 39 percent for patients treated with combination chemotherapy. Overall median survival time was 24 months and 36 months for those with adjuvant chemotherapy. Only histology grade, among the factors examined, was a significant prognostic factor for survival. The mean survival time of the patients with Stage II disease who received chemotherapy was 117.4 months, and it was 47.9 months for the patients with Stage II disease who did not received chemotherapy. CONCLUSIONS In our retrospective study high-grade lymphoma was the only significant adverse prognostic factor for survival. Receiving adjuvant chemotherapy significantly improved survival in patients with Stage II disease. Patients with diffuse large-cell type had better survival than patients with small noncleaved-cell type in Stage II high-grade lymphoma.
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Affiliation(s)
- C W Fan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
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10
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Breslin NP, Urbanski SJ, Shaffer EA. Mucosa-associated lymphoid tissue (MALT) lymphoma manifesting as multiple lymphomatosis polyposis of the gastrointestinal tract. Am J Gastroenterol 1999; 94:2540-5. [PMID: 10484022 DOI: 10.1111/j.1572-0241.1999.01393.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There have been a number of previous case reports of lymphomas in the form of multiple mucosal polyps affecting variable lengths of colonic and intestinal mucosa. Invariably these have been classified histologically as mantle cell lymphomas. We report a case of this rare syndrome that illustrates many of its typical features but which demonstrates significant histological and immunophenotypic differences. A 67-yr-old man was referred with a 3-month history of altered bowel habit and a barium enema suggestive of extensive ulcerative colitis. At colonoscopy, diffuse umbilicated mucosal polyps were seen throughout the colon and a larger circumferential mass lesion at the ileocecal valve. Biopsies demonstrated a diffuse B-cell lymphoma consistent with "multiple lymphomatous polyposis" of the colon. Flow cytometry revealed CD25 positive/CD5 negative lymphoid cells confirming marginal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. Upper gastrointestinal investigations confirmed similar involvement of the stomach, duodenum, and small bowel. Helicobacter pylori was absent. Flow cytometry abnormalities consistent with marrow involvement were present. These features led to a diagnosis of stage IV marginal zone B-cell lymphoma of MALT type, presenting as multiple lymphomatous polyposis of the gastrointestinal tract. Three months of combination chemotherapy resulted in an excellent symptomatic and endoscopic response.
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Affiliation(s)
- N P Breslin
- Department of Medicine (Division of Gastroenterology), University of Calgary, Alberta, Canada
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11
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Greil R. Primäre und sekundäre Lymphome des Gastrointestinaltraktes: Chemotherapie im primären, adjuvanten und palliativen Einsatz. Eur Surg 1998. [DOI: 10.1007/bf02620108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Lin KM, Penney DG, Mahmoud A, Chae W, Kolachalam RB, Young SC. Advantage of surgery and adjuvant chemotherapy in the treatment of primary gastrointestinal lymphoma. J Surg Oncol 1997; 64:237-41. [PMID: 9121156 DOI: 10.1002/(sici)1096-9098(199703)64:3<237::aid-jso11>3.0.co;2-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgery has been the mainstay of treatment for gastrointestinal (GI) lymphoma. The role of adjuvant chemotherapy to surgery has not been clearly elucidated. METHODS The review covered 100 patients who were diagnosed with primary GI lymphoma and treated from 1980 to 1993 at Providence Hospital (Southfield, MI), and Hartford and St. Francis Hospitals (Hartford, CT) with a median follow-up of 5 years. Forty-two patients were treated with surgery alone; 31 patients with surgery and adjuvant chemotherapy; 23 patients with primary chemotherapy, and 4 patients received no treatment. RESULTS The 5-year actuarial survival based on the above treatments calculated by life-table analysis were 57%, 76%, 58%, and 0%, respectively. This series showed that surgery with adjuvant chemotherapy significantly improved the 5-year actuarial survival of patients with primary GI Lymphoma and that primary chemotherapy showed comparable survival to surgery alone. There was no difference in prognosis when comparing patients with different stage, grade, or location of disease in the GI tract. CONCLUSIONS We recommend surgery when feasible with adjuvant chemotherapy as the mainstay of treatment for primary GI lymphoma. However, if a patient presents with comorbid factors, primary chemotherapy offers an effective alternative.
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Affiliation(s)
- K M Lin
- Department of General Surgery, Providence Hospital, Southfield, Michigan, USA
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13
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Lei KI, Chow JH, Johnson PJ. Aggressive primary natural killer cell lymphoma of the caecum: a case report and literature review. Clin Oncol (R Coll Radiol) 1997; 9:191-4. [PMID: 9269556 DOI: 10.1016/s0936-6555(97)80081-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An unusual case of aggressive Stage IIE(B) primary natural killer cell lymphoma of the caecum is described in a 16-year old Chinese girl. The immunophenotype of the tumour cells was CD2+, CD3-, CD4-, CD5-, CD7+, CD8-, CD45RO+, CD45RA-, CD56+, CD57-. Southern blot analysis showed a normal germline arrangements of the T-cell antigen receptor and immuno-globulin heavy chain genes. This lymphoma pursued a highly aggressive clinical course, with the rapid development of an extensive local recurrence after an apparently complete resection and combination cytotoxic therapy. The patient died 7 months after diagnosis, despite receiving salvage treatment. Given the aggressiveness and poor prognosis in this biologically distinct primary gastrointestinal lymphoma, a more vigorous systemic therapy should be considered in addition to surgery.
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Affiliation(s)
- K I Lei
- Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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14
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Nyui S, Osanai H, Masuoka H, Ohba S, Ebata T, Yoshida Y, Hoshi H, Shinohara Y. Primary malignant lymphoma of the rectum with distant metastasis to the stomach: report of a case. Surg Today 1997; 27:349-52. [PMID: 9086553 DOI: 10.1007/bf00941811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary extranodal malignant lymphoma frequently occurs in the gastrointestinal tract: however, it is rarely encountered in the rectum. We report herein the case of an 85-year-old man who underwent abdominoperineal resection for primary malignant lymphoma of the rectum, and 1 year later, developed hematemesis caused by gastric metastasis. To our knowledge this is the first case report of such distant metastasis developing from malignant lymphoma of the rectum.
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Affiliation(s)
- S Nyui
- Sapporo Memorial Hospital of Surgery, Japan
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15
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Case records of the Massachusetts general hospital. Weekly clinicopathological exercises. Case 28-1996. A 45-year-old woman with abdominal pain and a polypoid mass in the colon. N Engl J Med 1996; 335:807-12. [PMID: 8778587 DOI: 10.1056/nejm199609123351108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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16
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Abstract
This synthesis of the literature on radiotherapy for non-Hodgkin's lymphomas is based on 158 scientific articles, including 16 randomized studies, 18 prospective studies, and 90 retrospective studies. These studies involve 14,137 patients. Non-Hodgkin's lymphomas are highly radiosensitive, and local recurrence following radiotherapy is unusual. Radiotherapy probably cures approximately 50% of both low-grade and high-grade malignant NHL at stage I. Involved field is apparently sufficient, however, higher doses are required for high-grade malignant lymphomas. Chemotherapy is recommended for stage II. Consolidation radiotherapy after chemotherapy may increase the number of complete remissions. The value of adjuvant radiotherapy has not been confirmed. Radiotherapy plays a limited role at stages III and IV. Radiotherapy is clearly indicated for extranodal localized disease in the skin and in the orbit of the eye. It is important to identify groups and subgroups in whom radiotherapy alone is sufficient, ie, the risk for distant recurrence is small. MALT lymphoma belongs to this group. Radiotherapy is often valuable in palliative situations.
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17
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Affiliation(s)
- G Morphopoulos
- Department of Histopathology, Bolton General Hospital, UK
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18
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Lenzen R, Borchard F, Lübke H, Strohmeyer G. Colitis ulcerosa complicated by malignant lymphoma: case report and analysis of published works. Gut 1995; 36:306-10. [PMID: 7883235 PMCID: PMC1382423 DOI: 10.1136/gut.36.2.306] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 51 year old woman with a two year history of ulcerative colitis developed a wide spread gastrointestinal non-Hodgkin's lymphoma of low grade malignancy (MALT-lymphoma) involving upper and lower gastrointestinal tract, spleen, and bone marrow. After chemotherapy, clinical symptoms improved and lymphocytic infiltrates disappeared. Thirty nine cases of ulcerative colitis and 22 cases of Crohn's disease complicated by gastrointestinal lymphomas reported in published works are reviewed. In inflammatory bowel diseases any dense lymphocytic infiltrates seen in biopsy specimens obtained from ulcerative colitis or Crohn's disease should be assessed to exclude gastrointestinal lymphoma.
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Affiliation(s)
- R Lenzen
- Department of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
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19
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Mohideen MN, LeVay J, Gaffney CC. Primary rectal non-Hodgkin's lymphoma treated with radical radiotherapy. Clin Oncol (R Coll Radiol) 1995; 7:407-8. [PMID: 8590710 DOI: 10.1016/s0936-6555(05)80019-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A male patient with localized low grade stage IEA rectal non-Hodgkin's lymphoma is presented. The treatment of choice suggested by the literature is surgical excision, which, in this patient, would have resulted in abdominoperineal resection. He was successfully treated with radical radiotherapy and is well with no evidence of disease 4 years after treatment. A brief review of the literature on the clinical features, pathology and treatment of this condition is presented.
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20
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DiSario JA, Burt RW, Kendrick ML, McWhorter WP. Colorectal cancers of rare histologic types compared with adenocarcinomas. Dis Colon Rectum 1994; 37:1277-80. [PMID: 7995158 DOI: 10.1007/bf02257796] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To examine clinical characteristics of colorectal cancers of rare histologic types compared with adenocarcinomas. METHODS Review of a population-based registry with complete ascertainment. RESULTS There were 7,422 colorectal cancers, 4,900 (66 percent) colonic and 2,522 (34 percent) rectal. Two hundred fifty-five cancers (3 percent) were of nonadenocarcinoma varieties including 75 (33 percent) squamous, 74 (33 percent) malignant carcinoids, 37 (16 percent) transitional cell-like, 25 (11 percent) lymphomas, 9 (4 percent) sarcomas, and 2 (0.9 percent) melanomas. Sixty (1.2 percent) of the colon cancers occurred in the appendix, and proportionately more carcinoids accounted for these tumors. Compared with adenocarcinomas, colonic and rectal carcinoids and colonic lymphomas accounted for a larger proportion of cancers in the younger age groups. The elderly had proportionately fewer colonic carcinoids. Colonic carcinoids, rectal squamous-cell cancers, and rectal transitional cell-like cancers were more common in women. Colonic lymphomas had a worse prognosis than adenocarcinomas. Survival was better with colonic and rectal carcinoids and rectal transitional cell-like cancers than with adenocarcinomas. CONCLUSIONS Colorectal cancers of histologic varieties other than adenocarcinoma have distinctive epidemiologic and clinical traits.
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Affiliation(s)
- J A DiSario
- Division of Gastroenterology, University of Utah Health Sciences Center, Salt Lake City
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21
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Rutovitz JJ, Motum P. Primary large cell lymphoma of the rectum. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1992; 22:709. [PMID: 1489301 DOI: 10.1111/j.1445-5994.1992.tb04887.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
MESH Headings
- Aged
- Aged, 80 and over
- Biopsy
- Humans
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Rectal Neoplasms/epidemiology
- Rectal Neoplasms/pathology
- Rectal Neoplasms/therapy
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Affiliation(s)
- J J Rutovitz
- Repatriation General Hospital Concord, Sydney, NSW
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22
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RUTOVITZ JJ, MOTUM P. Primary large cell lymphoma of the rectum. Intern Med J 1992. [DOI: 10.1111/j.1445-5994.1992.tb00520.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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McCullough JE, Kim CH, Banks PM. Mantle zone lymphoma of the colon simulating diffuse inflammatory bowel disease. Role of immunohistochemistry in establishing the diagnosis. Dig Dis Sci 1992; 37:934-8. [PMID: 1587200 DOI: 10.1007/bf01300394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe the first reported case of mantle zone lymphoma of the colon presenting as diffuse ileocolitis simulating severe inflammatory bowel disease. This case serves to illustrate the importance of immunohistochemistry in establishing the diagnosis of lymphoma in extranodal sites.
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Affiliation(s)
- J E McCullough
- Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
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24
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Sharma AK, Shukla A, Prabhakar G, Mathur P, Sarin Y, Nijhawan S, Rai RR. Primary non-Hodgkins lymphoma of the rectum. Indian J Pediatr 1992; 59:378-9. [PMID: 1398875 DOI: 10.1007/bf02821809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A K Sharma
- Department of Pediatrics Surgery, S.M.S. Medical College & Attached S.P.M. Child Health Institute, Jaipur
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25
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Abstract
Primary colonic lymphoma is an increasingly recognised complication of ulcerative colitis. We report the first known case of rectal lymphoma occurring after colectomy and ileorectal anastomosis in ulcerative colitis.
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Affiliation(s)
- J P Teare
- Department of Gastroenterology, St Thomas's Hospital, London
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26
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Abstract
When all of the macroscopic and microscopic features of Crohn's disease and ulcerative colitis are present, the correct diagnosis is usually made without difficulty. When some of the changes are absent, the accuracy of diagnosis is reduced. This review has outlined those diseases which feature some of these pathological changes and may masquerade as idiopathic chronic inflammatory bowel disease. Some of the pathological mimics are iatrogenic while other common diseases, such as bacterial infection, ischaemia, and diverticulosis may produce confusing histological appearances. The picture is complicated by the fact that many of these pathological imitators may themselves cause or predispose to chronic inflammatory bowel disease, or may complicate chronic inflammatory bowel disease. For example, drugs and infectious agents are recognisable causes of relapse in ulcerative colitis; Crohn's disease may cause diverticulitis in patients with diverticulosis; and lymphoma may complicate ulcerative colitis. It behooves all practising histopathologists to recognise these mimics of ulcerative colitis and Crohn's disease to ensure appropriate management for patients with inflammatory pathology of the intestines.
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Affiliation(s)
- N A Shepherd
- Department of Histopathology, Gloucestershire Royal Hospital
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27
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Abstract
Primary GI lymphoma is a rare clinical entity. A primary nodal tumor should be ruled out. Symptoms may not be localizing and B symptoms are less common. A tissue diagnosis, preferably by transmural biopsy for small intestinal involvement, often reveals a high-grade morphology. The staging work-up should include a bone marrow examination, although formal staging laparatomy is not always required. Patients with Mushoff stage IE or IIE1 disease do better than those with extraregional nodal disease or distant metastatic involvement. Surgical resection with clear margins is required in order to maximize the changes for cure. Chemotherapy or radiotherapy may give a survival advantage when used as adjuvant treatment for selected stage IE and IIE disease. Chemotherapy should be used after surgical debulking in more advanced disease in order to minimize the chance for bleeding or performation. Future randomized, multi-institutional trials will give more direction as to the best modes of management.
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Affiliation(s)
- C R Thomas
- Department of Internal Medicine, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
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28
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Sagar SM, Karp SJ, Falzon M. Malignant lymphomatous polyposis: diagnosis and response to chemotherapy. Clin Oncol (R Coll Radiol) 1990; 2:230-4. [PMID: 2261420 DOI: 10.1016/s0936-6555(05)80174-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Malignant lymphomatous polyposis is a low-grade lymphoma with aggressive features. It may mimic polyposis coli on a barium enema and colonoscopic examination. An histological diagnosis may be made from a tissue biopsy taken via the colonoscope. We discuss the methods of diagnosis, the clinical behaviour and response to chemotherapy.
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Affiliation(s)
- S M Sagar
- Meyerstein Institute of Clinical Oncology, Middlesex Hospital, London, UK
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29
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The gut-associated lymphoid tissue and its tumours. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1990; 81:133-75. [PMID: 2407437 DOI: 10.1007/978-3-642-74662-8_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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30
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Ohri SK, Keane PF, Sackier JM, Hutton K, Wood CB. Primary rectal lymphoma and malignant lymphomatous polyposis. Two cases illustrating current methods in diagnosis and management. Dis Colon Rectum 1989; 32:1071-4. [PMID: 2591283 DOI: 10.1007/bf02553884] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Two cases of colorectal lymphoma are presented. Preoperative histologic diagnosis is difficult and examination of the fresh specimen using immunocytochemical and gene rearrangement techniques are necessary to establish the precise nature of the lesion. Surgical excision is the mainstay of treatment for localized lymphoma of the colorectum and chemotherapy for malignant lymphomatous polyposis.
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Affiliation(s)
- S K Ohri
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom
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31
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Shepherd NA, Hall PA, Williams GT, Codling BW, Jones EL, Levison DA, Morson BC. Primary malignant lymphoma of the large intestine complicating chronic inflammatory bowel disease. Histopathology 1989; 15:325-37. [PMID: 2680870 DOI: 10.1111/j.1365-2559.1989.tb01585.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ten cases of malignant lymphoma of the colon and rectum complicating chronic inflammatory bowel disease are presented. Seven patients had chronic ulcerative colitis with a history varying from 6 to 20 years. There was extensive colitis in six of these patients and left-sided colitis in one. All seven lymphomas showed the pathological and immunohistological features of primary B-cell tumours of the gastrointestinal tract with a predominance of high-grade tumours. Three patients had Crohn's disease of the large intestine complicated by malignant lymphoma of the sigmoid colon or rectum. The history of Crohn's disease varied from 30 months to 20 years and in each case there was fissuring and fistulae. There was extensive anal involvement in two cases. Histologically the three lymphomas were heterogeneous: one was of 'granulomatous' T-cell type and the other two were markedly polymorphic and of equivocal phenotype. They were also characterized by numerous multinucleate tumour giant cells. Primary colorectal malignant lymphoma should be regarded as a rare, but significant, complication of ulcerative colitis. Immunosuppression may be an additional factor in the genesis of intestinal lymphoma in Crohn's disease. The prognosis appears to be dependent on factors already known to be of prognostic significance in primary gut lymphomas: a predominance of high-grade tumours suggests that the outlook is generally worse than that for idiopathic primary large intestinal lymphoma.
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Affiliation(s)
- N A Shepherd
- Department of Histopathology, Gloucestershire Royal Hospital, Gloucester, UK
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32
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Shepherd NA, Hall PA, Coates PJ, Levison DA. Primary malignant lymphoma of the colon and rectum. A histopathological and immunohistochemical analysis of 45 cases with clinicopathological correlations. Histopathology 1988; 12:235-52. [PMID: 3366441 DOI: 10.1111/j.1365-2559.1988.tb01939.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Primary colorectal lymphoma accounts for only about 0.2% of large intestinal malignancies. Management difficulties are compounded by a lack of consistent pathological reporting and by the use of numerous different classifications. Forty-five cases of primary colorectal lymphoma are included in this study. The presenting features are indistinguishable from those of colorectal cancer. Seven patients had a history of chronic ulcerative colitis but no other predisposing factors were identified. Immunohistochemical studies showed that all tumours were of B-cell phenotype. Most tumours were difficult to characterize using standard pathological classifications such as Kiel, except for the 11 cases of malignant (multiple) lymphomatous polyposis, which were morphologically diffuse centrocytic lymphomas. Twenty-nine lymphomas showed the morphological and immunohistochemical features associated with tumours arising in mucosa-associated lymphoid tissue. These tumours showed variable but often marked polymorphism and we have used the term polymorphic B-cell lymphoma to describe them. Consistency was achieved between three observers as to whether these tumours were low or high grade, and grade was found to be prognostically important. A modified Dukes staging system was adopted and there was a trend for early stage to give prognostic advantage. This study supports the view that surgery should be the primary treatment for localized lymphoma of the gastrointestinal tract with radiotherapy and/or chemotherapy for advanced cases and for malignant lymphomatous polyposis.
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Affiliation(s)
- N A Shepherd
- ICRF Colorectal Cancer Unit, St. Mark's Hospital, London, UK
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