Primary colorectal lymphoma

Abstract

This study aimed at investigating the incidence, presentation, patient and tumor characteristics, treatment, and outcome of primary colorectal lymphomas (PCL) at a tertiary care center in Lebanon over a 25-year period. The Dawson's criteria were used for selection of eligible cases. The medical records were reviewed for demographic variables, the presence of risk factors, presenting signs and symptoms, method of diagnosis, histologic type, type of therapy, and condition at last follow-up. Nine cases of PCL were identified (12.7% of gastrointestinal lymphomas and 0.1% of colorectal malignancies). The mean age at presentation was 44.2 years with male predominance noted. Abdominal pain was the most common presentation (77.8%). Colonoscopy was performed for eight patients with non-specific gross tumor characteristics. Three patients had Burkitt's and six had diffuse large B-Cell lymphomas. The most common site of involvement was the cecum (55.6%) with all cases presenting in stage I(E). Surgery was performed for six patients followed by chemotherapy except for one, and three patients had chemotherapy only. The median survival time was 25 months and the 2-year survival time was approximated at 60%. It is concluded that PCL is a rare malignancy with well-identified disease characteristics yet controversial ideal management plan.

Primary Colorectal Lymphoma—Clinical Outcomes in a Population-Based Series

“…25 Within the large bowel, the cecum is constantly reported to be the most common site of lymphoma. 3,11,12,14,15,22,23 The relation with the presence of abundant lymphoid tissue in this region has been proposed as an explanation. 12 In our series, 51% of the cases was located in the cecum and 21% in the rectum.…”

“…The incidence varied from 0.1% to 0.9% in other series. [11][12][13][14][15] We identified a twofold increase in the rate of new cases by decade in the general population during the study period. The incidence of colorectal cancer in Alberta increased by 5%, whereas the incidence of all lymphomas increased by 10%, during the same period .…”

“…11,12,21 Maximal incidence of PCL has been reported between 5th and 7th decade with a mean age between 44 and 65 years. 12 In our cohort, the median age was 62 years. In our series, the age lower than 60 years old at diagnosis was the only variable associated with a better outcome.…”

“…Others have also reported similar symptoms in previous series. [11][12][13][14][15]23 Endoscopic evaluation was carried out in 27 patients and allowed for histological diagnosis in the majority of them (88.9%). In most of the cases, colonoscopy has shown mucosal irregularity or polypoid mass; few patients had ulceration or active bleeding.…”

Surgical resection combined with chemotherapy can help achieve better outcomes in patients with primary colonic lymphoma

“…The optimal treatment protocol for PCL is contentious [24,25]. Some authors have suggested systemic chemotherapy alone as the standard treatment, with surgery reserved for complications such as perforation, obstruction, and bleeding [8], whereas others believe that surgery provides better local disease control and improves survival outcome [14,26,27].…”