Endoscopic diagnosis of lower intestinal lesions of leukaemia and malignant lymphoma

Abstract

There have been only a few endoscopic studies with respect to lower intestinal lesions of leukaemia and malignant lymphoma, although there have been many autopsy studies of these lesions. The aim of this study was to clarify these lesions using endoscopy. Colonoscopy was performed on 11 of 341 patients with leukaemia and on 32 of 105 patients with malignant lymphoma for frequent diarrhoea, anal bleeding or abnormal findings on barium enema examination, between April 1984 and September 1994. In eight of the 11 patients with leukaemia on whom endoscopy was performed, nine lesions were found; aphthoid ulcers, small ulcers or large tumours due to leukaemic infiltration were found in five, and colorectal adenoma was found in only one patient. Antibiotic-associated haemorrhagic colitis or pseudomembranous colitis was found in one patient each. In 10 of the 32 patients with malignant lymphoma, 11 lesions were found. The following were found in one patient each: large lymphomatous tumours, a large lymphomatous ulcer, multiple small polypoid lesions, multiple lymphomatous polyposis; and colorectal cancer or adenoma in six patients. However, the autopsy findings in patients with both diseases were mostly pseudomembrane formation or ulcers due to fungal and/or bacterial infection. It is concluded that accurate endoscopic diagnosis of lower intestinal lesions in patients with leukaemia or malignant lymphoma is essential for staging and treatment of these diseases and for determining their prognosis. Most lesions in leukaemia are aphthoid and small ulcers are due to leukaemic infiltration or antibiotics; most lesions in malignant lymphoma are elevated lesions such as cancer, adenoma or lymphomatous lesions as determined by endoscopy. This is in contrast to pseudomembrane formation or ulcers due to fungal and/or bacterial infection which are detected at autopsy.

Risk of colorectal cancer in patients with hematologic disease

“…Results of the study suggest that patients with some hematologic diseases may often have colorectal cancer. So far, to our knowledge, there have been no reports on the relationship between hematologic diseases and colorectal cancer, although we have shown in a recent endoscopic study that patients with malignant lymphoma had colorectal neoplasms (cancer and adenoma) at an incidence higher than those with leukemia 6 . The present study, which is based on patients' histories and endoscopic, surgical or autopsy findings, shows that patients with PRCA, multiple myeloma or aplastic anemia have colorectal cancer at a significantly higher rate compared to those with leukemia.…”

“…An increase in the incidence of second malignancy, including solid tumors, was observed in patients with Hodgkin's disease, 2 primarily after radiotherapy alone or chemotherapy combined with radiotherapy 3 . A recent endoscopic study has shown an increased incidence of colorectal neoplasms in patients with malignant lymphoma 6 . However, it is unknown whether there is any association between malignant lymphoma and colorectal cancer.…”

“…Gastric cancers were reported to sometimes complicate malignant lymphoma 4,5 . We have demonstrated in a recent endoscopic study that patients with malignant lymphoma have colorectal neoplasms at an incidence higher than those with leukemia 6 . Vogelstein et al 7 reported the influence of K‐ras mutation, loss of p53 or deleted in colorectal cancer on the pathogenesis of colorectal cancer at each stage of development from adenoma to cancer 7–9 .…”

Gastrointestinal manifestations of leukemia

“…Infiltration of the small bowel may result in prominent mucosal folds, a protein‐losing enteropathy, 15 and impaired D‐xylose absorption 16 . A review of colonoscopies in leukemia shows that most lesions are aphthoid and small ulcers due to leukemic infiltration 17 . Also reported are reddish, flat or slightly elevated lesions, nodular lesions, and polypoid masses 12,18,19 .…”