Diffuse large B-cell lymphoma of the colon with synchronous liver metastasis: a rare case report mimicking metastatic colorectal adenocarcinoma

Abstract

BackgroundPrimary colorectal lymphoma represents a rare minority among the colonic neoplasms. Early diagnosis is often difficult because of unspecific symptoms, with subsequent delays in diagnosis and management. We describe a rare case of colonic lymphoma presenting with synchronous liver metastasis.Case presentationA 70-year-old male with a 6-mo history of vague abdominal pain, constipation and melena was referred to our hospital. Computed tomography scan of abdomen revealed the presence of a mass along the proximal ascending colon. Colonoscopy biopsy showed external compression of the cecum with two ulcerations of mucosa, but it was not consistent for a definitive diagnosis. Because the difficulties in the preoperative pathological diagnosis, the high risk of bowel obstruction and the correlated hemorrhagic risk, the patient underwent a right hemicolectomy associated with locoregional lymphadenectomy and liver resection.The surgically resected right colon and liver tumors were all immunohistochemically diagnosed as diffuse large B-cell lymphomas (DLBCL). The patient refused any other antineoplastic treatment; he is alive and free of disease at 3 years after initial diagnosis.ConclusionsPrimary colonic lymphomas represent a rare minority among the colonic neoplasms. Their correct pre-operative identification is crucial for the design of treatment. This case highlights the difficulty in diagnosing of primary colonic lymphoma. To our knowledge, this is the first report of a colonic lymphoma presenting with a colonic mass and a synchronous liver metastasis.

Primary Rectal Lymphoma with Synchronous Liver Involvement: An Extremely Rare Case Report

“…It is very difficult to differentiate PRL based on clinical and radiological findings from adenocarcinoma rectum with hepatic metastasis. [6,7] PRL occur more often in conditions of immunosuppression (HIV infection), inflammatory bowel disease (ulcerative colitis), and following organ transplantation. [2] Men are affected twice as common as women, with the mean age of 55 years at diagnosis.…”

A Rare Case of Primary Diffuse Large B-cell Lymphoma of the Colon

“…Despite the sever luminal narrowing, as seen in our patients, it rarely causes obstruction because it does not show a desmoplastic reaction and infiltration of the malignant cell weakens the muscularis propria of the colonic wall. There may be a resemblance in phenotypic appearance and correct diagnosis is often challenging (2). The presentation to the healthcare setting is non-specific and patients do present with occasional abdominal pain with or without bowel changes, and weight loss.…”

Primary B-Cell Lymphoma of Caecum Presenting as an Ulcerative Lesion in a Young Male

“…B-cell type has better prognosis as compared with T-cell lymphoma. 10 Immunohistochemistry is a useful adjunct in subclassification of NHL pan-B-cell markers such as CD20, CD19, CD22, CD45, and CD79a are generally expressed in BCLU. CD10 is expressed in 30 to 60% of cases.…”