Primary diffuse large B-cell lymphoma of the cecum

When found in the cecum or rectosigmoid junction, primary colorectal B-cell lymphoma is a rare malignant non-Hodgkin's lymphoma often associated with an unfavorable prognosis. Due to the nonspecific clinical symptoms, these uncommon tumors are often left undefined or misdiagnosed, resulting in delays in treatment and adverse patient outcomes. Contrast-enhanced computed tomography is the most commonly used medical imaging process for primary colorectal lymphoma, but due to the rarity of this disorder, accurate imaging diagnosis remains a clinical challenge. In this article, we report the case of a 70-year-old male who was diagnosed with primary B-cell lymphoma of the cecum. We focus on improving diagnosis through the utilization of radiological imaging modalities, particularly computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18-F-FDG PET/CT). While imaging modalities are important in recognizing colonic lymphomas, there are no pathognomonic imaging features for lymphoma; therefore, biopsy remains necessary for diagnostic confirmation.

Primary colorectal diffuse large B-cell lymphoma: A report of eighteen cases in a tertiary care center

Primary colorectal diffuse large B-cell lymphoma (DLBCL) is very rare colon malignancy. It is important to know the main demographic and clinical characteristics of these patients. We conducted a retrospective analysis of 18 patients diagnosed with primary colorectal DLBCL during a 17-year period at the National Cancer Institute of Brazil (INCA) between 2000 and 2018. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) levels, treatment modality and follow-up status were obtained from medical records. Survival was estimated from the date of diagnosis until death. There were 11 male and seven female patients in our cohort, the median age at diagnosis was 59.5 years and four patients were HIV positive. Tumor was mainly localized in the right colon. Patients were treated with chemotherapy (CT) and/or surgical resection. Eleven patients died during a median follow-up of 59 months and the median survival time was 10 months. Six or more cycles of CT (HR=0.19; CI 95% 0.054-0.660, p = 0.009), LDH levels below 350 U/L (HR=0.229; CI 95% 0.060-0.876, p = 0.031) and surgical resection (HR=0.23; CI 95% 0.065-0.828, p = 0.030) were associated with reduced risk of death in univariate analysis. Patient's age and DLBCL right colon localization should be considered at diagnosis to distinguish between DLBCL and other diseases for differential diagnosis. Six cycles of CT, LDH levels below 350 U/L and surgical resection were associated with better survival. Our results are consistent with previous publications and address the importance of correct colorectal DLBCL diagnosis and treatment.

Primary colorectal lymphoma - A single centre experience

PURPOSE

The incidence of primary colorectal lymphoma (PCL) is rare (0.2-0.6% of large bowel malignancy). Up to one third of Non-Hodgkin's lymphoma will present with extra-nodal manifestations only. Extra-nodal lymphomas arise from tissues other than the lymph nodes and even from sites, which contain no lymphoid tissue. The incidence of Non-Hodgkin's lymphoma has increased over the past fifty years. The objective of this study was to examine our experience of PCL.

METHODS

A prospectively-compiled database (1988-2012) of patients with colorectal cancer was retrospectively examined for cases of colorectal lymphoma. A retrospective chart review identified cases of PCL based on Dawson's criteria. Clinical information was obtained from case notes.

RESULTS

Eleven patients (0.3% of 4219 patients) were identified (6 male, 5 female). The median age at diagnosis was 63 years. Mode of presentation varied; abdominal pain, a palpable mass and per rectal bleeding being the most frequent. The caecum was the most frequently involved site (5/11). Nine patients underwent surgical management, one had chemotherapy alone and one had radiotherapy alone. All cases were non-Hodgkin's lymphoma, with diffuse large B-cell lymphoma in majority. The median event-free survival of those treated with surgery and post-operative chemotherapy was 10 months (range 5-120 months).

CONCLUSION

Primary colorectal lymphoma is rare. Management is multidisciplinary and dependent on the subtype of lymphoma. Due to the rarity of diagnosis, there is a paucity of randomised control trials. Most information published is based on individual case reports and there is, thus, no clear treatment algorithm for these cases.