Lymphoma arising in an S-pouch after total proctocolectomy for ulcerative colitis

Abstract

The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. We present a case of a 50-year-old male with primary B cell lymphoma arising in an S-pouch eight years after a total proctocolectomy for ulcerative colitis. After chemoradiotherapy the patient remained asymptomatic, with an intact S-pouch. Pouch conservation is feasible in patients with primary lymphoma of the pouch, using chemoradiotherapy and close follow-up examinations.

Evaluating Lymphoma Risk in Inflammatory Bowel Disease

“…Gastric mantle cell lymphoma has also been reported by Raderer et al in a patient with a 14 year history of Crohn's disease (Raderer et al, 2004). Ileal pouch lymphoma has also been reported in a number of other publications (Sengul et al, 2008, Frizzi et al, 2000, Nyam et al, 1997 and one publication suggests EBV may be involved in the aetiology (Schwartz et al, 2006). Lymphoma at an ileostomy site has also been reported (Pranesh, 2002).…”

Risk of dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis

“…Ten reports of adenocarcinoma either in the anorectal mucosa or ileo‐anal pouch in patients with FAP have been published in the literature [72–80] and two patients of adenocarcinoma in the ileo‐anal anastomotic region have been reported following RPC in patients with Crohn's disease [81,82]. Two patients of lymphoma [83,84] in the ileo‐anal pouch and one patient of adenocarcinoma in a Kock pouch [85], all following the diagnosis of UC have also been reported. Ravitch [86], in his presidential address to the American College of Surgeons, had mentioned a patient of squamous cell carcinoma of the anal mucosa following RPC and this year there has been another report [87] of a squamous cell carcinoma at the anorectal ring.…”

Dysplasia in the ileoanal pouch

“…The authors considered it a matter of speculation as to whether this was coincidental or related to chronic pouchitis. The second case occurred after 8 years of follow-up and pouch conservation was possible after treatment with chemoradiotherapy [83].…”

“…However, preservation of the pouch may be possible in selected cases by pouch revision surgery [15]. In those rare cases of pouch lymphoma, pouch excision may or may not be required depending on response to chemoradiotherapy [82,83].…”