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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.
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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
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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
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2
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Chung YK, Park SB. Rapidly growing primary anal canal lymphoma: a case report and literature review. Gastroenterol Rep (Oxf) 2023; 11:goad058. [PMID: 37745182 PMCID: PMC10517634 DOI: 10.1093/gastro/goad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/21/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Yu Kyung Chung
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Arif M, Radakovitz J, Kulkarni P, Hepburn I. Rare Presentation of Primary Classical Hodgkin Lymphoma of a Rectosigmoid Colon in a 79-Year-Old With a History of Irritable Bowel Syndrome. Cureus 2023; 15:e43465. [PMID: 37711930 PMCID: PMC10498938 DOI: 10.7759/cureus.43465] [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] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
We discuss the case of a 79-year-old immunocompetent male who presented with weight loss and diarrhea and ultimately was found to have a rectosigmoid mass on a colonoscopy. Even though initial biopsies obtained during colonoscopy were non-diagnostic, considering the likelihood of malignancy, lower anterior resection was performed, and pathology confirmed the diagnosis of primary Hodgkin's lymphoma of the sigmoid colon. Hodgkin's lymphoma typically presents as painless supra-diaphragmatic lymphadenopathy with B symptoms such as fever, unexplained weight loss, and drenching night sweats. Due to the rarity of primary Hodgkin lymphoma in the colon and its non-specific initial presentation, we believe sharing this case will bring awareness to the atypical presentation of Hodgkin lymphomas.
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Affiliation(s)
- Mobeena Arif
- Family Medicine Residency Program, WellSpan Good Samaritan Hospital, Lebanon, USA
| | - Joseph Radakovitz
- Family Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Pallavi Kulkarni
- Family and Community Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Iryna Hepburn
- Gastroenterology, Wellspan Good Samaritan Hospital, Lebanon, USA
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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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5
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Yachida T, Matsuda T, Sakamoto T, Nakajima T, Kakugawa Y, Maeshima AM, Taniguchi H, Kushima R, Tobinai K, Kobara H, Masugata H, Masaki T, Saito Y. Endoscopic features of colorectal lymphoma according to histological type. JGH OPEN 2022; 6:257-262. [PMID: 35475204 PMCID: PMC9021707 DOI: 10.1002/jgh3.12738] [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: 09/21/2021] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 11/09/2022]
Abstract
Background and Aim This study aimed to investigate the relationship between the histological type of colorectal lymphoma and its endoscopic features. Methods We retrospectively analyzed patients with primary colorectal lymphoma who were diagnosed using colonoscopy and biopsy specimens at the National Cancer Center Hospital, Tokyo, Japan. The lesions were macroscopically classified into the following types via colonoscopy: polypoid, ulcerative, multiple lymphomatous polyposis, diffuse, and mixed. Results A total of 117 lesions were identified in 90 patients enrolled in this study. Of these, 59 (50%) were located in the ileocecal region, 23 (20%) in the rectum, 9 (8%) in the transverse colon, 8 (7%) in the sigmoid colon, 7 (6%) in the descending colon, and 4 (3%) in the ascending colon. Moreover, the most common histological subtypes were diffuse large B‐cell lymphoma (DLBCL) in 39 patients (43%) and mantle cell lymphoma (MCL) in 23 patients (26%), followed by follicular lymphoma (FL; 17%), mucosa‐associated lymphoid tissue (MALT) lymphoma (9%), peripheral T‐cell lymphoma‐NOS (2%), monomorphic epitheliotropic intestinal T‐cell lymphoma (MEITL; 2%), and Burkitt lymphoma (1%). More than half of the DLBCL (52%), MCL (52%), and MALT (56%) lymphomas were macroscopically classified as polypoid types. In contrast, FL lesions showed various macroscopic types. The majority of DLBCL (62%) and FL (78%) lesions were distributed in the ileocecal region. MCL lesions tended to be widely spread in various sites of the large intestine. Conclusions Colorectal lymphomas showed macroscopically distinctive features depending on the histological type. Understanding the macroscopic classification of the lesions by colonoscopy and its distribution may be helpful in diagnosing the type of lymphoma and determining the malignant grade based on the histological types.
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Affiliation(s)
- Tatsuo Yachida
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
- Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
- Department of General Internal Medicine, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Takahisa Matsuda
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | - Taku Sakamoto
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | - Takeshi Nakajima
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | - Yasuo Kakugawa
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | | | - Hirokazu Taniguchi
- Department of Pathology National Cancer Center Hospital Chuo City Tokyo Japan
- Pathology and Clinical Laboratory Division JR Tokyo General Hospital Shibuya City Tokyo Japan
| | - Ryoji Kushima
- Department of Pathology National Cancer Center Hospital Chuo City Tokyo Japan
- Department of Clinical Laboratory Medicine and Diagnostic Pathology Shiga University of Medical Science Otsu Shiga Japan
| | - Kensei Tobinai
- Department of Hematology National Cancer Center Hospital Chuo City Tokyo Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Hisashi Masugata
- Department of General Internal Medicine, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Yutaka Saito
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
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Yu H. Primary colonic lymphoma in patients with inflammatory bowel disease: Is it treatment‐ or disease‐related adverse event? ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hsien‐Chung Yu
- Health Management Center Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Department of Nursing Meiho Institute of Technology Pingtung Taiwan
- Institute of BioPharmaceutical Sciences, National Sun Yat‐sen University Kaohsiung Taiwan
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Meir E, Handler C, Kaplan U, Kopelman D, Hatoum OA. Primary small cell type of non-Hodgkin lymphoma of the colon: a case report. J Med Case Rep 2020; 14:157. [PMID: 32948246 PMCID: PMC7501666 DOI: 10.1186/s13256-020-02500-y] [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: 05/30/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Primary lymphoma of the colon is exceedingly rare and comprises 0.2–1% of all colon tumors. The most common subtype of lymphoma in the colon is non-Hodgkin lymphoma. Symptoms are often nonspecific, and treatment varies between chemotherapy alone and a combination of surgery and chemotherapy. Case presentation We describe a case of a Ashkenazi Jew patient who presented in the typical way that carcinoma of the colon might present but turned out to have a very rare type of tumor in both its histology and its location. Conclusion There was apparent discordance between the relative bulkiness and gross appearance of the tumor with the unrevealing result of the biopsies, demanding a high level of suspicion as to the actual presence and possible type of such a tumor in the future.
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Affiliation(s)
- Eyal Meir
- Department of Surgery B, Emek Medical Center, Afula, Israel.,Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chovav Handler
- Department of Surgery B, Emek Medical Center, Afula, Israel.,Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Uri Kaplan
- Department of Surgery B, Emek Medical Center, Afula, Israel.,Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Doron Kopelman
- Department of Surgery B, Emek Medical Center, Afula, Israel.,Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ossama A Hatoum
- Department of Surgery B, Emek Medical Center, Afula, Israel. .,Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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8
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Lin C, Lin C, Leong Y, Tung C, Shun C, Wei S, Wong J, Weng M. Ulcerative colitis associated with primary colorectal lymphoma in Taiwan: A tertiary center study. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Cheng‐Lu Lin
- Department of Internal Medicine Far Eastern Memorial Hospital New Taipei City Taiwan
| | - Cheng‐Kuan Lin
- Department of Internal Medicine Far Eastern Memorial Hospital New Taipei City Taiwan
| | - Yew‐Loong Leong
- Department of Internal Medicine West Garden Hospital Taipei Taiwan
| | - Chien‐Chih Tung
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Chia‐Tung Shun
- Department and Graduate Institute of Forensic Medicine College of Medicine, National Taiwan University Taipei Taiwan
| | - Shu‐Chen Wei
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Jau‐Min Wong
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Meng‐Tzu Weng
- Department of Internal Medicine Far Eastern Memorial Hospital New Taipei City Taiwan
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
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Abstract
BACKGROUND Primary colorectal lymphoma is rare, representing 0.2% to 0.6% of all colorectal cancers. Because of its low incidence and histologic variety, no treatment guidelines exist. OBJECTIVE The purpose was to report the experience of primary colorectal lymphoma in an institutional and a national cohort. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted with institutional data composed of 3 tertiary referral centers and national data. PATIENTS Patients with primary colorectal lymphoma were identified within the Mayo Clinic (1990-2016) and the Surveillance, Epidemiology, and End Results database (1990-2014). MAIN OUTCOME MEASURES Primary outcomes were overall and 5-year survival. RESULTS For the institutional cohort (N = 82), 5-year survival was 79.9%. Five-year survival was higher for rectal (88.4%) than for colon tumors (77.2%; p = 0.004). On multivariable analysis, age <50 years was associated with higher overall survival (p = 0.04). Left-sided colon masses and aggressive histological subtypes were associated with worse survival (0.04 and 0.03). No effect of treatment modality on survival was noted. For the national cohort (N = 2942), 5-year survival was 58.4%. Five-year survival for rectal tumors was 61.0% and 57.8% for colon tumors. On multivariable analysis, factors associated with improved survival were age <70 y, (p < 0.0001), female sex (p = 0.005), right-sided masses (p = 0.02), and diagnoses after 2000 compared with 1990-1999 (p < 0.0001). Aggressive pathology (p < 0.0001) and stage III or stage IV presentation compared with stage I (p = 0.02 and p < 0.0001) were associated with worse survival. LIMITATIONS The institutional cohort was limited by sample size to describe treatment effect on survival. A major limitation of the national cohort was the ability to describe treatment modalities other than surgery, including chemotherapy and/or no additional treatment. CONCLUSIONS Poorer survival was noted in elderly patients and in those with aggressive pathology. An overall survival advantage was seen in women in the national cohort. Currently, optimal strategies should follow a patient-centered multidisciplinary approach. See Video Abstract at http://links.lww.com/DCR/A807. LINFOMA COLORECTAL PRIMARIO EXPERIENCIA INSTITUCIONAL Y REVISIÓN DE UNA BASE DE DATOS NACIONAL: El linfoma colorectal primario es poco frecuente, representando del 0.2% al 0.6% de todos los cánceres colorectales. Debido a su baja incidencia y variedad histológica, no existen guías de tratamiento. OBJETIVO El propósito fue reportar la experiencia en linfoma colorectal primario en una cohorte institucional y una nacional. DISEÑO:: Este fue un estudio de cohorte retrospectivo. ESCENARIO El estudio se realizó con datos institucionales provenientes de 3 centros de referencia terciarios y datos nacionales. PACIENTES Se identificaron pacientes con linfoma colorectal primario en la base de datos de la Clínica Mayo (1990-2016) y en la base de datos de vigilancia, epidemiología y resultados finales [Surveillance, Epidemiology, and End Results database (1990-2014)]. PRINCIPALES MEDIDAS DE RESULTADO Los resultados primarios fueron la sobrevida general y a 5 años. RESULTADOS Para la cohorte institucional (N = 82), la sobrevida a 5 años fue de 79.9%. La sobrevida a cinco años fue mayor en tumores rectales (88.4%) que en los de colon (77.2%; p = 0.004). En el análisis multivariable, la edad <50 años se asoció con una mayor sobrevida general (p = 0,04). Las masas de colon izquierdo y los subtipos histológicos agresivos se asociaron con una peor sobrevida (0.04 y 0.03). No se observó ningún efecto según la modalidad de tratamiento en la sobrevida. Para la cohorte nacional (N = 2942), la sobrevida a 5 años fue del 58.4%. La sobrevida a cinco años fue de 61.0% para los tumores rectales y 57.8% para los tumores de colon. En el análisis multivariable, los factores asociados con una mayor sobrevida fueron edad <70 años, (p <0.0001), sexo femenino (p = 0.005), masas derechas (p = 0.02) y los casos diagnósticados después del año 2000 comparados con los de 1990-1999 (p <0.0001). Histopatología agresiva (p <0.0001) y presentación en estadio III o estadio IV en comparación con estadio I (p = 0.02 y p <0.0001) se asociaron con una peor sobrevida. LIMITACIONES La cohorte institucional estuvo limitada por el tamaño de la muestra para describir el efecto del tratamiento en la sobrevida. Una limitación mayor en la cohorte nacional fue la habilidad para describir modalidades de tratamiento distintas a la cirugía, incluyendo quimioterapia y/o ningún tratamiento adicional. CONCLUSIONES Una menor sobrevida fue documentada en pacientes de edad avanzada y en aquellos con histopatología agresiva. Se observó ventaja en cuanto a sobrevida general en las mujeres de la cohorte nacional. Actualmente, las estrategias óptimas deben de seguir un abordaje multidisciplinario centrado en cada paciente. Vea el abstract en video en http://links.lww.com/DCR/A807.
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Abstract
BACKGROUND Colon and rectal lymphomas are rare and can occur in the context of posttransplant lymphoproliferative disorder. Evidence-based management guidelines are lacking. OBJECTIVE The purpose of this study was to characterize the presentation, diagnosis, and management of colorectal lymphoma and to identify differences within the transplant population. DESIGN This was a retrospective review of patients evaluated for colorectal lymphoma between 2000 and 2017. Patients were identified through clinical note queries. SETTINGS Four hospitals within a single health system were included. PATIENTS Fifty-two patients (64% men; mean age = 64 y; range, 26-91 y) were identified. No patient had <3 months of follow-up. Eight patients (15%) had posttransplant lymphoproliferative disorder. MAIN OUTCOME MEASURES Overall survival, recurrence, and complications in treatment pathway were measured. RESULTS Most common presentations were rectal bleeding (27%), abdominal pain (23%), and diarrhea (23%). The most common location was the cecum (62%). Most frequent histologies were diffuse large B-cell lymphoma (48%) and mantle cell lymphoma (25%). Posttransplant lymphoproliferative disorder occurred in the cecum (n = 4) and rectum (n = 4). Twenty patients (38%) were managed with chemotherapy; 25 patients (48%) underwent primary resection. Mass lesions had a higher risk of urgent surgical resection (35% vs 8%; p = 0.017). Three patients (15%) treated with chemotherapy presented with perforation requiring emergency surgery. Overall survival was 77 months (range, 25-180 mo). Patients with cecal involvement had longer overall survival (96 vs 26 mo; p = 0.038); immunosuppressed patients had shorter survival (16 vs 96 mo; p = 0.006). Survival in patients treated with surgical management versus chemotherapy was similar (67 vs 105 mo; p = 0.62). LIMITATIONS This was a retrospective chart review, with data limited by the contents of the medical chart. This was a small sample size. CONCLUSIONS Colorectal lymphoma is rare, with variable treatment approaches. Patients with noncecal involvement and chronic immunosuppression had worse overall survival. Patients with mass lesions, particularly cecal masses, are at higher risk to require urgent intervention, and primary resection should be considered. See Video Abstract at http://links.lww.com/DCR/A929.
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Pandey M, Swain J, Iyer HM, Shukla M. Primary lymphoma of the colon: report of two cases and review of literature. World J Surg Oncol 2019; 17:18. [PMID: 30646907 PMCID: PMC6334463 DOI: 10.1186/s12957-018-1548-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal tract is the most frequent site of extranodal lymphoma accounting for approximately 40% of all extranodal lymphomas; out of these, non-Hodgkin's lymphoma (NHL) comprises 4% of total cases. Primary lymphoma arising in the colon is very rare comprising only 0.2-1% of all colonic malignancy. PATIENTS AND METHODS We report two cases of 13- and 20-year-old boys with NHL of colon presenting with abdominal pain and weight loss and discuss the approach to colonic lymphoma after a review of world literature to provide an overview on colonic lymphoma. RESULTS Colonic NHL most commonly affects older age group with mean age of diagnosis being 55 years. Abdominal pain and weight loss are the two most common presentations with palpable abdominal mass as physical examination finding in half of the cases. CONCLUSIONS Colonic lymphoma in young adolescence is rare. Multimodality approach involving both surgery and chemotherapy is the principal mode of treatment. Radiotherapy is used in selected cases. If diagnosed preoperatively, non-surgical management can be attempted.
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Affiliation(s)
- Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005 India
| | - Jyoti Swain
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005 India
| | - Hema Malini Iyer
- Department of Histopathology, Lal Path Labs, New Delhi, India
- Dharamsheela Cancer Centre, Delhi, India
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12
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Colonic lymphoma presented as acute abdomen; A case report and review of literature. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.401832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Ren Y, Chen Z, Su C, Tong H, Qian W. Diffuse large B-cell lymphoma in colon confounded by prior history of colorectal cancer: A case report and literature review. Oncol Lett 2016; 11:1493-1495. [PMID: 26893766 DOI: 10.3892/ol.2016.4078] [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: 12/10/2014] [Accepted: 11/13/2015] [Indexed: 11/06/2022] Open
Abstract
A 66-year-old male underwent left hemicolectomy for rectal adenocarcinoma in 2008. Five years later he was admitted to hospital with abdominal pain. A computed tomography scan revealed notable thickening of the middle of the ascending colon wall, and colonoscopy revealed an ulcerofungating mass of 3×3 cm in the cecum and extending to the ascending colon. Under the consideration of cancer recurrence, laparoscopic right hemicolectomy was performed directly. Surgical specimens revealed sheets of large pleomorphic lymphoid cells with nuclei of different sizes, nucleoli and mitotic phases visible in most cells. These tested positive for CD45, CD20 and CD79a diffusely, but negative for CD3, CD5, Bcl-2, Bcl-6 and ALK. The Ki-67 proliferation index was 40%. Epstein-Barr virus in situ hybridization did not reveal any positive signals in any of the tumor cells. Based on these findings, the recurrent tumor was diagnosed as diffuse large B-cell lymphoma. The patient could have avoided surgery and received chemotherapy only; however, the case was confounded by the patient's prior history of colorectal cancer due to the rarity of colon lymphoma following rectal cancer in the same patient. It is therefore essential to investigate carefully and differentiate between potential lesions during routine postoperative colonoscopy following colorectal cancer surgery, as patients may present with rare colon lymphoma, which may be confused with a recurrence of colorectal cancer.
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Affiliation(s)
- Yanling Ren
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhilu Chen
- Department of Hematology, Tongde Hospital of Zhejiang, Hangzhou, Zhejiang 310012, P.R. China
| | - Chuanyong Su
- Department of Hematology, Tongde Hospital of Zhejiang, Hangzhou, Zhejiang 310012, P.R. China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Wenbin Qian
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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15
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[Primary Hodgkin's lymphoma of the colon]. DER PATHOLOGE 2013; 35:191-5. [PMID: 23793289 DOI: 10.1007/s00292-013-1790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary Hodgkin's lymphoma of the colon is exceedingly rare. We report on the case of a 74-year-old female patient presenting with weight loss and hematochezia. Proctocolonoscopy revealed a bleeding tumor localized in the right colonic flexure. Histological examination of initial mucosal biopsies could not verify malignancy; however, explorative surgery was decided in an interdisciplinary conference setting and right-sided hemicolectomy was performed. Macroscopically, a tumor measuring 5.5 cm in maximum diameter was found. By means of histology and immunohistochemistry the diagnosis of classic Hodgkin's lymphoma was made. Mesenteric lymph nodes were not affected and postoperative staging revealed no systemic spread. Therefore, the tumor fulfilled the criteria of a primary colonic Hodgkin's lymphoma. Diagnosis of primary colonic lymphoma can be difficult as clinical symptoms are typically unspecific and, as shown in this case, even primary biopsy histology can be falsely negative.
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Barbaryan A, Ali AM, Kwatra SG, Saba R, Prueksaritanond S, Hussain N, Mirrakhimov AE, Vladimirskiy N, Zdunek T, Gilman AD. Primary diffuse large B-cell lymphoma of the ascending colon. Rare Tumors 2013; 5:85-8. [PMID: 23888223 PMCID: PMC3719118 DOI: 10.4081/rt.2013.e23] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 02/08/2023] Open
Abstract
Primary colorectal lymphoma is a rare malignancy accounting for 3% of all gastrointestinal lymphomas and 0.1-0.5% of all colorectal malignancies. Among primary colorectal lymphomas, the most common histological subtype of colorectal lymphoma is diffuse large B-cell lymphoma. We report a case of an 84-year old Caucasian female who was admitted to the hospital because of a 2 days history of altered mental status. In the emergency department the patient was found to have acute kidney injury and hypercalcemia. On physical examination a large lower quadrant abdominal mass was palpated. Computed tomography scan of abdomen confirmed the presence of a mass along the cecum and proximal ascending colon. Colonoscopy showed a large ulcerated mass and biopsy was consistent with diffuse large B-cell lymphoma. The patient underwent colectomy but refused to receive chemotherapy.
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Mahfoud T, Tanz R, Khmamouche MR, Regragui A, Ichou M, Errihani H. Primary non-Hodgkin's lymphoma of the colon: a case report and literature review. J Gastrointest Cancer 2012; 43:619-21. [PMID: 22843239 DOI: 10.1007/s12029-012-9406-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tarik Mahfoud
- Department of Medical Oncology, Military Hospital Mohammed V, Rabat, Morocco.
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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.
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Primary colorectal lymphoma: case series and literature review. Asian J Surg 2011; 34:111-4. [PMID: 22208685 DOI: 10.1016/j.asjsur.2011.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 02/11/2011] [Accepted: 04/14/2011] [Indexed: 01/10/2023] Open
Abstract
Primary colorectal lymphoma is a rare disease that accounts for 0.16% of colorectal malignancies. Treatments include surgical intervention with or without chemotherapy. Outcome of this intervention among the Chinese population are lacking. Perforation resulting from chemotherapy may need further exploration. A retrospective review of patient records was performed among those who were diagnosed with colorectal malignancy in a single center from January 1998 to June 2009. Ten patients met Dawson's diagnostic criteria for primary colorectal lymphoma [0.66% (10/1516) of all colorectal malignancies]. The male-to-female ratio was 9:1, and median age at diagnosis was 76 years. The most common site was the cecum (n = 5). B-cell lymphoma was present in eight patients. Seven patients underwent surgical intervention. The median follow-up of all patients was 16.5 months. Median survival was 17 months and 13 months in the surgical and chemotherapy group, respectively. Primary colonic lymphoma is a rare disease. Surgical intervention appeared to be superior to chemotherapy alone, but the findings were limited by the small number of patients in this study. Whether surgery or chemotherapy should be offered first remains unknown and requires further research.
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Primary colorectal lymphoma-clinical outcomes in a population-based series. J Gastrointest Surg 2011; 15:1851-7. [PMID: 21647770 DOI: 10.1007/s11605-011-1572-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/11/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to investigate the characteristics and the outcomes of primary colorectal lymphomas using a population-based registry. METHODS All cases of colorectal lymphoma diagnosed between 1980 and 2007 were identified using a provincial cancer registry. Patients meeting Dawson's criteria and having a negative bone marrow biopsy were included. RESULTS One hundred ten cases of colorectal lymphoma were identified, 43 met the inclusion criteria. The majority of patients was male (86%), and the median age at diagnosis was 62 (range 26-82) years. Tumors were mostly located in the cecum (51.1%) and rectum (20.9%). The 5-year overall survival rate calculated by the Kaplan-Meier method was 57%. Age under 60 was associated with a better median survival time (265 vs 54 months; p < 0.0001). The surgical treatment was associated with a better overall survival compared to medical treatment alone (110 vs 56 months; p = 0.083). Tumors located in the rectum were associated with a decreased overall survival (41 months vs 110 months; p = 0.065). CONCLUSIONS Primary colorectal lymphoma is a rare disease. The age at diagnosis is an important predictor of outcome. Surgical resection may be associated with improved survival. Rectal lymphoma appears to be associated with a worse outcome and may warrant more aggressive therapy.
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Tang TC, Kuo MC, Chang H, Dunn P, Wang PN, Wu JH, Lin TL, Hung YS, Kuo TT, Shih LY. Primary colonic lymphoma: an analysis of 74 cases with localized large-cell lymphoma. Eur J Haematol 2011; 87:28-36. [DOI: 10.1111/j.1600-0609.2011.01632.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lai YL, Lin JK, Liang WY, Huang YC, Chang SC. Surgical resection combined with chemotherapy can help achieve better outcomes in patients with primary colonic lymphoma. J Surg Oncol 2011; 104:265-8. [PMID: 21472731 DOI: 10.1002/jso.21927] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 03/14/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The colon is a rare location for gastrointestinal non-Hodgkin's lymphoma. We retrospectively analyzed the demographic data of patients with colonic lymphoma and the possible prognostic factors of the disease. METHODS We studied data obtained from 6,944 patients and performed a retrospective review of patients with primary colonic lymphoma (PCL) by using a pathology registry database. We employed well-established and accepted diagnostic criteria and clinical staging method. RESULTS Twenty-nine patients (19 men; 10 women) were diagnosed with PCL. The cecum was the most common tumor location (14/29 patients), and 17 cases (17/29) showed diffuse large-B-cell lymphomas. Four patients died of sepsis within 30 days of an emergency surgery for perforation of intestine. Two-thirds of the patients were in the early disease stages (stages I and II). The overall 5-year survival rate was 47.3%. Disease stage was not a prognostic factor for survival. The overall 5-year survival rate in patients treated with surgery followed by chemotherapy was statistically significant as compared to that in the patients treated with chemotherapy alone. CONCLUSION PCL is a rare malignancy of the gastrointestinal tract, and surgical resection should be considered a part of the standard treatment to achieve a better outcome.
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Affiliation(s)
- Yi-Ling Lai
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Shigeno T, Fujimori K, Tsuruta F, Nozawa Y, Nagaya T, Maejima T. Ileocecal collision tumor composed of adenocarcinoma and primary malignant lymphoma. Clin J Gastroenterol 2011; 4:79-84. [PMID: 26190710 DOI: 10.1007/s12328-011-0206-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 01/04/2011] [Indexed: 01/07/2023]
Abstract
Collision tumor means that two kinds of histologically distinct tumors coexist and neighbor without histological interminglement. This report describes a rare case of an ileocecal collision tumor composed of adenocarcinoma and primary malignant lymphoma. A 76-year-old woman was referred to our institute with anemia and a right lower quadrant mass. Colonoscopy revealed type 2 advanced colon cancer in the cecum accompanied by a submucosal mound neighboring this cancer, which appeared different from the usual shape of colon cancer. A barium enema study manifested the typical apple-core sign in the cecum with a smooth semicircular line appearing in the shadow of the apple-core sign. Biopsy specimens showed adenocarcinoma, so a right hemicolectomy was performed. The gross resected specimen presented a mass measuring 64 × 58 × 28 mm at the ileocecal portion. The half of this mass on the colonic side had a crater-like appearance, whereas the remaining part of the mass on the ileal side had an aspect with a smooth surface. Microscopic examination disclosed that the mass was composed of adenocarcinoma and malignant lymphoma bordering on each other and mediated by a thin layer of connective tissue. Cases of colon tumors with an unusual epithelial and submucosal appearance may be instances of collision tumors composed of cancer and malignant lymphoma.
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Affiliation(s)
- Takashi Shigeno
- Department of Gastroenterology, National Nagano Hospital, 1-27-21 Midorigaoka, Ueda, Nagano, 386-8610, Japan.
| | - Kazuya Fujimori
- Department of Gastroenterology, National Nagano Hospital, 1-27-21 Midorigaoka, Ueda, Nagano, 386-8610, Japan
| | - Fumito Tsuruta
- Department of Gastroenterology, National Nagano Hospital, 1-27-21 Midorigaoka, Ueda, Nagano, 386-8610, Japan
| | - Yuichi Nozawa
- Department of Gastroenterology, National Nagano Hospital, 1-27-21 Midorigaoka, Ueda, Nagano, 386-8610, Japan
| | - Tadanobu Nagaya
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
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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.
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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
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Wang T, Gui W, Shen Q. Primary gastrointestinal non-Hodgkin’s lymphoma: clinicopathological and prognostic analysis. Med Oncol 2009; 27:661-6. [DOI: 10.1007/s12032-009-9265-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 06/18/2009] [Indexed: 01/31/2023]
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