Simultaneous occurrence of colonic adenocarcinoma and MALT lymphoma: A series of three cases

A collision tumor of nasopharyngeal carcinoma and primary mantle cell lymphoma in the nasopharynx: a case report and review of the literature

BACKGROUND

Nasopharyngeal carcinoma (NPC) is more common in men aged 40 to 59, and radiotherapy is an effective treatment. Nasopharyngeal lymphoma (NPL) is rare, and the coexistence of nasopharyngeal mantle cell lymphoma (MCL) and NPC is even rarer. A collision tumor is a rare type of tumor that refers to two or more different tumors occurring in the same organ. No reports to date have described a collision tumor of NPC and MCL occurring within the same nasopharyngeal mass. We herein report the successful treatment of a unique case of synchronous coexistence of NPC and MCL occurring in the nasopharynx of a Chinese man.

CASE PRESENTATION

A 58-year-old man presented with a 5-month history of swallowing discomfort. Biopsy was performed under nasopharyngeal endoscopy, and histopathology revealed NPC. Magnetic resonance imaging revealed lesions in the nasopharynx, oropharynx, and tonsils, as well as enlarged lymph nodes in the parotid gland, posterior ear, and neck. This may be a synchronous dual primary tumor coexisting with NPC and NPL. Pathology consultation confirmed that the biopsy specimen of the nasopharynx was a collision tumor of NPC and MCL. Positron emission tomography computed tomography (PET-CT) revealed thickening of the posterior wall of the nasopharynx, which was considered NPC with lymphoma. The enlargement of the pharyngeal lymph ring and multiple hypermetabolic lymph nodes were evaluated as lymphoma infiltration. The patient received two courses of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by head and neck radiotherapy. At the time of this writing, he had remained alive without recurrence for 61 months since the initial treatment and was still undergoing follow-up.

CONCLUSIONS

It is very important to correctly recognize collision tumors. Magnetic resonance imaging helps identify different components of collision tumors. Pathological examination helps to confirm the diagnosis. Histological examination reveals different components, and PET-CT can help determine the extent of the lesion. Dose-adjusted chemotherapy combined with radiotherapy may have promising herapeutic effects, but additional case studies are needed to confirm.

Collision tumor of primary malignant lymphoma and adenocarcinoma in the colon diagnosed by molecular pathology: A case report and literature review

BACKGROUND

Collision tumors of primary malignant lymphoma and adenocarcinoma in the colon are rare. Primary diffuse large B-cell lymphoma (DLBCL)-adenocarcinoma collision tumors are especially rare.

CASE SUMMARY

A 74-year-old woman presented with abdominal pain of 1 mo duration. Biopsy under colonoscopy revealed adenocarcinoma of the ascending colon. Subsequently, the patient underwent laparoscopic radical resection of right colon cancer with lymph node dissection. A collision tumor was found incidentally through postoperative pathological sampling. Genetic analysis showed a collision tumor of DLBCL with germinal center B-cell subtype and TP53 mutation, and adenocarcinoma arising in a tubulovillous adenoma in the colon, with BRAF mutation and mutL homolog 1 promoter methylation. The patient died 3 mo after surgery. To our knowledge, this is the 23rd reported case of collision tumor of colorectal adenocarcinoma and lymphoma. The mean age of the 23 patients was 73 years. The most common site was the cecum. There were 15 cases with follow-up data including 11 living and four dead with a 3-year overall survival rate of 71.5%.

CONCLUSION

Based on pathological and genetic analysis, surgery combined with chemotherapy or chemoradiotherapy may have good therapeutic effects for collision tumor.

[What to do in front of the association between colonic adenocarcinoma and lymphoma ?]

Synchronous presentation of a colonic adenocarcinoma and lymphoma is extremely rare. We describe here, the sixth observation of a marginal zone B-cell lymphoma, which was incidentally diagnosed in a 77-year-old patient, who was operated for adenocarcinoma of hepatic flexure. This case shows the importance to be aware of this rare association and highlights the dilemma of its management.

Synchronous colonic B cell lymphoma and adenocarcinoma in an elderly patient treated with R-mini-CHOP followed by resection

The simultaneous diagnosis of colonic lymphoma and adenocarcinoma in the same location is rare and presents challenges in its treatment considerations, especially in elderly patients. While previous cases have been described, there is little consistency in treatment regimens, and outcomes are generally poor. We describe the case of a man in his late 80s who presented with primary cecal and colonic B cell lymphoma, treated with R-mini-CHOP chemotherapy, but was found to have a residual adenocarcinoma in the cecum after treatment that was then successfully resected. The patient remains alive and well 3 years postoperation. This case highlights the need to consider lymphoma as a possible diagnosis for any colonic mass, and the need to consider rebiopsy of residual abnormal-appearing tissue postchemotherapy to confirm the diagnosis. Moreover, our report affirms that aggressive, curative-intent treatment with age-adjusted chemotherapy, and subsequent surgical resection is feasible for certain elderly patients with dual malignant diagnoses.

Synchronous adenocarcinoma and marginal zone B-cell lymphoma of the colon. A case report

Introduction and importance

The association of colonic adenocarcinoma with lymphoma is a rare entity. The purpose of our presentation is to draw the attention of the endoscopist, and the surgeon, to the need to remove any suspicious lesions in the exploration for colorectal cancer. The pathologist should be warned about this association in the face of any unusual change in the lymphatic environment around an adenocarcinoma. In the slightest doubt, an immunohistochemistry (IHC) should be performed in order not to ignore this association.

Case presentation

A 77-year-old patient, who had adenocarcinoma of the right colic flexure, in whom a chance discovery of lymphoma was made intraoperatively. This combination was treated with chemotherapy targeting adenocarcinoma classified as pT4N1M0, ahead of the low-grade lymphoma malignancy. After two years, the patient presented with a recurrence as left lateral cervical lymphadenopathy and died in a picture of generalized paralysis.

Clinical discussion

Digestive lymphoma associated with adneocarcinoma is defined according to strict criteria according to DAWSON. It always precedes adenocarcinoma because it disrupts the subject's immunocompetence.

His diagnosis is suspected when the lymphatic environment around the adenocarcinoma is disturbed. The confirmation is assured with the IHC. Treatment should target the most aggressive cancer.

Conclusion

The synchronous colonic occurrence of a MALT-type lymphoma and an adenocarcinoma is rare but possible. The pathologist must be alert to its existence. Treatment depends on the tumor stage of the adenocarcinoma but also on the lymphoma and its grade and any therapeutic decision should only be made in a multidisciplinary meeting.

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Lymphoma by impairing the subject's immunocompetence could accelerate the malignant degeneration of an existing precancerous colonic lesion to an adenocarcinoma.

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Any erasure of the architecture of lymph nodes in the dissection specimen of colonic adenocarcinoma giving rise to suspicion of lymphomatous infiltration, should confirmed by immunohistochemical testing.

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If an association between colonic adenocarcinoma and lymphoma is encountred, the most aggressive and/or evoluted neoplasm must be targeted in priority.

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The first treatment of a digestive lymphomatous pathology associated with an adenocarcinoma can provoke general dissemination.

Synchronous colonic mucosa-associated lymphoid tissue lymphoma found after surgery for adenocarcinoma: A case report and review of literature

BACKGROUND

Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of non-Hodgkin lymphoma that is mainly involved in the gastrointestinal tract. The synchronous occurrence of colonic MALT lymphoma and adenocarcinoma in the same patient is extremely rare. We here report a case of synchronous colonic MALT lymphoma found on surveillance colonoscopy five months after surgery and chemotherapy for sigmoid adenocarcinoma.

CASE SUMMARY

A 67-year-old man was admitted because of hematochezia for two months. Colonoscopy suggested a colonic tumor before hospitalization. Abdominal computed tomography (CT) revealed local thickening of the sigmoid colon. The patient underwent a left hemicolectomy with local lymph node dissection. The histopathology revealed moderately differentiated adenocarcinoma and partially mucinous adenocarcinoma. The pTNM stage was T3N1Mx. The patient received chemotherapy with six cycles of mFOLFOX6 after surgery. Colonoscopy was performed five months later and revealed single, flat, polypoid lesions of the colon 33 cm away from the anus. Subsequently, the patient underwent endoscopic mucosal resection for further diagnosis. The pathological diagnosis was MALT lymphoma. Positron emission tomography /CT suggested metastasis. The patient refused further treatment and died ten months later.

CONCLUSION

Colonic MALT lymphoma may occur after surgery and chemotherapy for adenocarcinoma as a synchronous malignancy. Regular surveillance colonoscopy and careful monitoring after surgery are critical.

Recent advances in intestinal lymphomas

A large variety of lymphoma types may develop as primary intestinal neoplasms in the small intestines or, less often, in the colorectum. Among these are a few entities such as enteropathy-associated T-cell lymphoma or immunoproliferative small intestinal disease that, essentially, do not arise elsewhere than in the gastrointestinal tract. In most instances the primary intestinal lymphomas belong to entities that also occur in lymph nodes or other mucosal sites, and may show some peculiar features. In the case of follicular lymphoma, important differences exist between the classical nodal cases and the intestinal cases, considered as a variant of the disease. It is likely that the local intestinal mucosal microenvironment is a determinant in influencing the pathobiological features of the disease. In this review we will present an update on the clinical, pathological and molecular features of the lymphoid neoplasms that most commonly involve the intestines, incorporating recent developments with respect to their pathobiology and classification. We will emphasize and discuss the major differential diagnostic problems encountered in practice, including the benign reactive or atypical lymphoid hyperplasias, indolent lymphoproliferative disorders of T or natural killer (NK) cells, and Epstein-Barr virus (EBV)-related lymphoproliferations.

Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up

Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed.

Colonic adenocarcinoma, mucosa associated lymphoid tissue lymphoma and tuberculosis in a segment of colon: A case report

Synchronous occurrence of adenocarcinoma and mucosa associated lymphoid tissue (MALT) lymphoma of colon is rare, and its presence with coexisting tuberculosis is still rarer. To our knowledge, this may be the first case report. In the present report, we describe a 43-year-old female who presented with a history of abdominal pain, fever, loss of weight and loss of appetite. Colonoscopy showed a large ulceroproliferative mass arising from the caecum, biopsy of which showed it to be adenocarcinoma of the colon. A right hemicolectomy was performed and microscopic study of the colon revealed tuberculosis and synchronous adenocarcinoma with lymphoma. Eight of sixteen lymph nodes showed tuberculosis and three of sixteenpericoloniclymphnodes showed metastatic deposits. Immunostains further confirmed the tumour to be adenocarcinoma with MALT lymphoma. We would like to highlight the diagnostic challenges arising from the multi-faceted presentations of these three conditions.

Secondary mucosa-associated lymphoid tissue (MALT) lymphoma of the colon

Mucosa-associated lymphoid tissue (MALT)-type lymphomas most commonly occur in the stomach and have been associated with Helicobacter pylori infection. However, MALT-type lymphoma of the colon is a rare entity. It commonly manifests with symptoms of weight loss, low-grade fever, constipation, melena, and hematochezia. Unlike gastric lymphoma, it is difficult to detect MALT-type lymphoma of the colon by imaging. Colonoscopy may reveal lesions whose biopsy most commonly shows abundant B lymphocytes. There is no universal immunohistochemistry profile for MALT-type lymphoma but CD 20 staining is commonly seen. Trisomies and translocations have been described and their presence has been correlated with treatment response. Due to the rarity of colonic MALT-type lymphoma, no standard guidelines are available for its management. It often occurs individually and rarely occurs simultaneously with concurrent colon adenocarcinoma. This case report describes the presentation and clinical course of a secondary MALT-type lymphoma in a patient who underwent colectomy for a prior colon adenocarcinoma.