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

Primary Rectal Non-Hodgkin's Lymphoma Treated with Urgent Radiotherapy and Chemotherapy: A Case Report and Literature Review

Rectal malignancy is usually symptomatic due to its location, and most of the time presents with pain and bleeding due to its growth and ulceration. It is difficult to identify the primary as carcinoma or lymphoma based on symptoms only, as both have a similar presentation. As it presents the rarest form of histology, non-Hodgkin's lymphoma in the rectum is still difficult to diagnose initially, and its treatment is debatable. We describe the case of a 49-year-old male from Bangladesh with the same presentation. His treatment was delayed for more than a month as immunohistochemistry and staging delayed the final diagnosis. The disease was diagnosed as stage IE with the help of a positron emission tomography (PET)-CT scan, and due to the local progression the patient had a massive rectal bleeding that needed an urgent intervention. Radiotherapy was applied to stop the bleeding. Hypofraction followed by a conventional fraction of external beam radiotherapy (EBRT) with a total of 40 Gy was applied. Post-EBRT digital rectal examination showed no residual except scaring, and a PET scan was also negative for residual disease. Due to uncertainties and lack of any precious guideline, 6 cycles of adjuvant chemotherapy with the R-CHOP schedule were also completed. Without surgery, the combination of EBRT and chemotherapy helped to preserve the organ, and the patient has been disease free for more than 2.5 years since his treatment.

Rectal Mucinous Adenocarcinoma Invading Retrorectal Dermoid Cysts: A Case Report

Rectal mucinous adenocarcinoma is a subtype of colorectal adenocarcinoma, which is more aggressive and prone to invade adjacent normal organs or tissues compared with non-mucinous adenocarcinoma. Retrorectal dermoid cyst is a rare congenital disease, which usually are benign but with a potential for malignant degeneration. In this article, we report a case which presented a rectal mucinous adenocarcinoma invading into retrorectal dermoid cysts, indicating that besides adjacent normal organs or tissues, malignancies can also invade adjacent tumors, making their diagnosis and management more complicated. In such cases, double primary tumors should be considered, and they should be removed surgically.

Intestinal lymphoma--a review of the management of emergency presentations to the general surgeon

INTRODUCTION

Intestinal non-Hodgkin's lymphoma (NHL) is uncommon but not rare. This paper aims to review the recent evidence for the management of perforated NHL of the intestine, consider when chemotherapy should be commenced and examine the likely outcomes and prognosis for patients presenting as surgical emergencies with this condition.

METHODS

MEDLINE and Cochrane databases were searched using intestinal lymphoma, clinical presentation, perforation, management and prognosis. The full text of relevant articles was retrieved and reference lists checked for additional articles.

FINDINGS

Emergency surgery was required at disease presentation for between 11 and 64% of intestinal NHL cases. Perforation occurs in 1-25% of cases, and also occurs whilst on chemotherapy for NHL. Intestinal bleeding occurs in 2-22% of cases. Obstruction occurs more commonly in small bowel (5-39%) than large bowel NHL and intussusceptions occur in up to 46%. Prognosis is generally poor, especially for T cell lymphomas.

CONCLUSIONS

There is a lack of quality evidence for the elective and emergency treatment of NHL involving the small and large intestine. There is a lack of information regarding the impact an emergency presentation has on the timing of postoperative chemotherapy and overall prognosis. It is proposed that in order to develop evidence-based treatment protocols, there should be an intestinal NHL registry.

Surgical resection combined with chemotherapy can help achieve better outcomes in patients with primary colonic lymphoma

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.