Primary lymphoma of the colon

Abstract

Background: primary colorectal lymphoma is a very rare disease, representing less than 0.5 % of all primary colorectal neoplasms. The gastrointestinal tract is the most frequently involved site of all extranodal lymphomas, the most common type of that is non-Hodgkin s lymphoma. Early diagnosis is often difficult because of unspecific symptoms. Therapeutic approaches have classically included radical resection, chemotherapy and radiotherapy.Materials and methods: we present our experience in the management of primary colorectal lymphomas over a 17-year period .Results: in this period 7 cases of primary colorectal lymphoma were diagnosed in our institution. Abdominal pain and change in bowel habit were the most frequent symptoms. Five patients underwent emergency surgery because of bleeding or bowel obstruction. All primary intestinal lymphomas studied were of the B-cell phenotype. Patients were followed up for a median of 59 months (range 1-180). Three of them are alive with no evidence of recurrence.Conclusion: combination treatment with chemotherapy and surgery can obtain good remission rate. Surgery can resolve complications such bleeding or intestinal perforation that are implicated in lymphoma mortality.Key words: Lymphoma. Colon. Surgery. Treatment. INTRODUCTIONPrimary lymphoma of the colon and rectum is a rare tumor. It comprises only 0.2-1.2 % of all colonic malignancies (1,2). The gastrointestinal (GI) tract is the most frequently extranodal involved site, accounting for 30-40 % of all cases (1,3). The predominant location of GI lymphomas is the stomach (50-60 %) (4) followed by small bowel (20-30 %), and colon and rectum (10-20 %) (5). To establish the diagnosis it is necessary to have a high index of suspicion because the variability of symptoms.Treatment often involves a multidisciplinary approach, combining surgery and chemotherapy, with the use of radiotherapy in selected cases. However, there are no randomized trials and treatment decisions are mainly based on expert opinions or consensus.We present the experience of primary colorectal lymphomas over a 15-year period in a single center. PATIENTS AND METHODSWe performed a retrospective descriptive study of all consecutive cases of primary colorectal lymphoma diagnosed in our institution from 1994 to 2011. The registry of the Department of Pathology was used for this purpose.All cases were histologically confirmed. The type of lymphoma was classified according to the WHO classification system (6). Immunohistochemical analysis (IHC) was performed to classify lymphomas as germinal center B-cell (GCB) or non-germinal center B-cell (ABC) subtypes (7). A computed tomography scan (CT) and a bone marrow biopsy was performed to determine what stage of the Ann Arbor Staging System for gastrointestinal lymphoma was used.The following clinical information was obtained: Age, sex, presentation, site of tumor, operation performed, his- Primary lymphoma of the colon

Primary Diffuse Large B-cell Lymphoma of the Sigmoid Colon

“…Recent advances in gene expression profiling and immunohistochemical (IHC) analysis on tissue biopsy have allowed us to differentiate the subtypes of DLBCL and tailor treatment to each type. For example, patients with the activated B-cell (ABC) disease subtype are less likely to respond well to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based regimens than those with germinal center B-cell (GCB) disease [6]. Cornerstone treatment options include chemotherapy, radiation therapy, surgery, bone marrow transplantation, or stem cell transplantation, with the latter two options implemented if response to treatment is not complete or if the chance of recurrence is high, with radiation therapy being the least preferred due to a high risk of small and large intestine complications [7].…”

Localized primary gastrointestinal diffuse large B cell lymphoma received a surgical approach: an analysis of prognostic factors and comparison of staging systems in 101 patients from a single institution

“…Surgery was once the standard procedure or a regular component of combined treatment modalities in primary gastrointestinal DLBCL (PG-DLBCL) [ 3 ]. The factors in favor of a surgical approach include the removal of primary lesions, availability of precise histological classification and staging, as well as avoidance of complications such as perforation or hemorrhage that may occur during radiotherapy and chemotherapy [ 4 – 6 ]. In the recent years, opinion has increasingly swung toward non-invasive treatment even for patients with resectable disease, so as to maintain their quality of life [ 7 – 9 ].…”

A rare case of diffuse large B-cell lymphoma presenting as a malignant mass in both duodenum and ascending colon

“…Endoscopy/colonoscopy with biopsy of the lesion remains the diagnostic modality of choice in the workup of colorectal lymphoma [7] . CT scan, MRI, and/or PET-CT play an important role in determining the extension of the disease and help in staging the disease [8] .…”