Endoscopic features of colorectal lymphoma according to histological type

Abstract

Background and Aim This study aimed to investigate the relationship between the histological type of colorectal lymphoma and its endoscopic features. Methods We retrospectively analyzed patients with primary colorectal lymphoma who were diagnosed using colonoscopy and biopsy specimens at the National Cancer Center Hospital, Tokyo, Japan. The lesions were macroscopically classified into the following types via colonoscopy: polypoid, ulcerative, multiple lymphomatous polyposis, diffuse, and mixed. Results A total of 117 lesions were identified in 90 patients enrolled in this study. Of these, 59 (50%) were located in the ileocecal region, 23 (20%) in the rectum, 9 (8%) in the transverse colon, 8 (7%) in the sigmoid colon, 7 (6%) in the descending colon, and 4 (3%) in the ascending colon. Moreover, the most common histological subtypes were diffuse large B‐cell lymphoma (DLBCL) in 39 patients (43%) and mantle cell lymphoma (MCL) in 23 patients (26%), followed by follicular lymphoma (FL; 17%), mucosa‐associated lymphoid tissue (MALT) lymphoma (9%), peripheral T‐cell lymphoma‐NOS (2%), monomorphic epitheliotropic intestinal T‐cell lymphoma (MEITL; 2%), and Burkitt lymphoma (1%). More than half of the DLBCL (52%), MCL (52%), and MALT (56%) lymphomas were macroscopically classified as polypoid types. In contrast, FL lesions showed various macroscopic types. The majority of DLBCL (62%) and FL (78%) lesions were distributed in the ileocecal region. MCL lesions tended to be widely spread in various sites of the large intestine. Conclusions Colorectal lymphomas showed macroscopically distinctive features depending on the histological type. Understanding the macroscopic classification of the lesions by colonoscopy and its distribution may be helpful in diagnosing the type of lymphoma and determining the malignant grade based on the histological types.

Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study

“…In our study, colorectal DLBCL lymphomas manifested as a protruding type with or without ulcer (which was consistent with the polypoid type). This was similar to a study by Yachida that reported that in 48 cases of DLBCL lymphoma in the large intestine, and 52% of lesions showed a polypoid appearance via endoscopy, and 38% were of the ulcerative type [37]. Yoshifumi Hori also found that the polypoid and ulcerative types were predominant in colorectal DLBCL lymphomas, accounting for 48% and 44%, respectively [30].…”

“…In addition, not all cases of lymphomatous polyposis of the digestive tract are caused by MCL. Multiple lymphomatous polyposis has also been observed in MALT and follicular lymphomas [37,53].…”

Intestinal T-cell lymphomas NOS presenting as a polypoidal lesion: A case report

“…However, relevant studies about ITCL are rare due to low incidence and lack of endoscopic findings specificity. The few existing studies have reported the most common endoscopic abnormalities in intestinal lymphoma are the ulcerated lesion followed by eminence lesion, in addition to the diffusely infiltratively lesion and lymphomatous polyposis lesion et al [12][13][14] Ulcerated lesions may present multiple or solitary, various in size, different in shades, irregular in shape, the edges are flat or irregularly thickened. Yet those performance is often misdiagnosed as inflammatory bowel disease.…”

Rare primary rectal mucosa-associated lymphoid tissue lymphoma with curative resection by endoscopic submucosal dissection: A case report and review of literature

“…It is also important to take into consideration the endoscopic and clinical presentations[ 19 ]. Endoscopic findings are nonspecific, ranging from a single polypoid lesion to a subepithelial tumour type, an epithelial mass type, and an ileitis type[ 14 ]. EUS is an accurate technique for evaluating the extent and invasion of the lesion.…”