Synchronous Rectal Adenocarcinoma and Splenic Marginal Zone Lymphoma

Abstract

Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl).A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made.The patient's management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil-leucovorin-oxaliplatin) chemotherapy and has remained disease-free for 7 years.To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation.

Synchronous or collision solid neoplasms and lymphomas: A systematic review of 308 case reports

“…1). [12–262] The data were extracted from the abstract in 34 articles, [17,37–39,64,75,76,78,81,94,97,103,129,134,151,162,166,170,174,176,192,195,212,221,222,229,232,234,251,252,256,260–262] of which 21 were in English, 5 in Japanese, 3 in Spanish, 2 in French, 2 in Chinese, and 1 in Czech.…”

Multiple primary tumors: Colorectal carcinoma and non-Hodgkin’s lymphoma

“…The pathophysiology of MPMN remains poorly understood, but risk factors may include tobacco and alcohol intake, infections, immunosuppression, genetic predisposition, and toxic effects related to chemotherapy or radiotherapy treatments [ 16 ]. With regards to CRC and NHL, it has been suggested that lymphoma may be the initial event that suppresses the patient's defenses against the development of colorectal carcinoma [ [16] , [17] , [18] ]. On the other hand, Hirano et al [ 19 ] reported a patient with hereditary nonpolyposis colorectal cancer who developed NHL after curative resection of CRC.…”