[Primary colorectal lymphomas]

Diffuse Large B-Cell Lymphoma of the Cecum

Lymphoma when arising from sites other than lymph nodes is termed extranodal lymphoma, commonly affecting the gastrointestinal tract. Primary colorectal lymphoma is a rare phenomenon among malignancies affecting the colon. We report a case of a patient with a history of Burkitt lymphoma in remission, presenting with a large cecal mass and a new diagnosis of diffuse large B-cell lymphoma treated with chemotherapy.

Delayed diagnosis of a high-grade B-cell non-Hodgkin's lymphoma presenting as an obstructing rectal mass

This case describes a 54-year-old man who presented to the surgical triage unit and was found to have a rare underlying rectal lymphoma. The patient had previously sought medical advice on multiple occasions, reporting a chronic inability to open his bowels. This case report aims to highlight the importance of thorough history taking and examination, in order to reduce delaying the diagnosis of significant pathology.

NonHodgkin's Lymphoma with Peritoneal Localization

The gastrointestinal tract is the most common extranodal site involved with lymphoma accounting for 5–20% of all cases. Lymphoma can occur at any site of the body, but diffuse and extensive involvement of the peritoneal cavity is unusual and rare. We report a case of diffuse large B-cell lymphoma in a 57-year-old female infiltrating the peritoneum and omentum and presenting with ascites and pleural effusion. The performed examinations did not discover any pathological findings affecting the digestive tract or parenchymal organs, except for diffuse thickening of the peritoneum and omentum. Peripheral, mediastinal, or retroperitoneal lymphadenopathy was not registered. The blood count revealed only elevated leukocytes and on examination there were no immature blood cells in the peripheral blood. The cytology from the ascites and pleural effusion did not detect any malignant cells. Due to the rapid disease progression the patient died after twenty-two days of admission. The diagnosis was discovered postmortem with the histological examination and immunohistochemical study of the material taken during the surgical laparoscopy performed four days before the lethal outcome. Although cytology is diagnostic in most cases, laparoscopy with peritoneal biopsy is the only procedure which can establish the definitive diagnosis of peritoneal lymphomatosis.

Primary diffuse large B-cell lymphoma of the ascending colon

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.

Colonic lymphoma presenting acutely with perforated colo-splenic fistula

INTRODUCTION

Primary colonic lymphoma is rare. It comprises less than 1% of large bowel malignancies. Affected patients often present with non-specific vague symptoms with subsequent delays in diagnosis and management.

PRESENTATION OF CASE

An immuno-competent 35-year-old male presented with left iliac fossa pain, fever and constipation. Clinical examination revealed left-sided abdominal peritonism. After the initial radiological and endoscopic investigations, a provisional diagnosis of a localized perforation of a splenic flexure diverticulum was made and ultrasound-guided percutaneous drainage of the abscess was performed. The patient failed to settle on conservative treatment and therefore exploratory laparotomy was carried out. An inflammatory phlegmon consisting of a left paracolic gutter abscess, the spleen and the splenic flexure of the colon was resected en-bloc and a primary colo-colic anastomosis was performed. His operative recovery was complicated by wound infection which was treated conservatively. The histopathology revealed colo-splenic fistula secondary to a perforated colonic non-Hodgkin's lymphoma. The spleen contained multiple metastatic lymphomatous deposits. He was started on chemotherapy and remained well at 5-year follow up.

DISCUSSION

Colon non-Hodgkin's lymphoma may present initially with an acute abdomen due to perforation. It mimics any acute surgical condition. Perforation and fistulaization into the spleen is very rare.

CONCLUSION

This case highlights the delay and difficulty in diagnosing primary colonic lymphoma without resorting to surgical resection.

Primary colorectal lymphoma: An overview

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.