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Rizk RC, Yasrab M, Weisberg EM, Fishman EK. Primary diffuse large B-cell lymphoma of the cecum. Radiol Case Rep 2024; 19:922-926. [PMID: 38188947 PMCID: PMC10767273 DOI: 10.1016/j.radcr.2023.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Abstract
When found in the cecum or rectosigmoid junction, primary colorectal B-cell lymphoma is a rare malignant non-Hodgkin's lymphoma often associated with an unfavorable prognosis. Due to the nonspecific clinical symptoms, these uncommon tumors are often left undefined or misdiagnosed, resulting in delays in treatment and adverse patient outcomes. Contrast-enhanced computed tomography is the most commonly used medical imaging process for primary colorectal lymphoma, but due to the rarity of this disorder, accurate imaging diagnosis remains a clinical challenge. In this article, we report the case of a 70-year-old male who was diagnosed with primary B-cell lymphoma of the cecum. We focus on improving diagnosis through the utilization of radiological imaging modalities, particularly computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18-F-FDG PET/CT). While imaging modalities are important in recognizing colonic lymphomas, there are no pathognomonic imaging features for lymphoma; therefore, biopsy remains necessary for diagnostic confirmation.
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Affiliation(s)
- Ryan C. Rizk
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Mohammad Yasrab
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Edmund M. Weisberg
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St, Baltimore, MD 21287 USA
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Vasconcelos FDC, Araujo RODC, Bernardo PS, Hancio T, de Moraes GN, Bigni RDS, Valadão M, Pinto LW, Maia RC. Primary colorectal diffuse large B-cell lymphoma: A report of eighteen cases in a tertiary care center. Cancer Treat Res Commun 2023; 36:100722. [PMID: 37331034 DOI: 10.1016/j.ctarc.2023.100722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023]
Abstract
Primary colorectal diffuse large B-cell lymphoma (DLBCL) is very rare colon malignancy. It is important to know the main demographic and clinical characteristics of these patients. We conducted a retrospective analysis of 18 patients diagnosed with primary colorectal DLBCL during a 17-year period at the National Cancer Institute of Brazil (INCA) between 2000 and 2018. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) levels, treatment modality and follow-up status were obtained from medical records. Survival was estimated from the date of diagnosis until death. There were 11 male and seven female patients in our cohort, the median age at diagnosis was 59.5 years and four patients were HIV positive. Tumor was mainly localized in the right colon. Patients were treated with chemotherapy (CT) and/or surgical resection. Eleven patients died during a median follow-up of 59 months and the median survival time was 10 months. Six or more cycles of CT (HR=0.19; CI 95% 0.054-0.660, p = 0.009), LDH levels below 350 U/L (HR=0.229; CI 95% 0.060-0.876, p = 0.031) and surgical resection (HR=0.23; CI 95% 0.065-0.828, p = 0.030) were associated with reduced risk of death in univariate analysis. Patient's age and DLBCL right colon localization should be considered at diagnosis to distinguish between DLBCL and other diseases for differential diagnosis. Six cycles of CT, LDH levels below 350 U/L and surgical resection were associated with better survival. Our results are consistent with previous publications and address the importance of correct colorectal DLBCL diagnosis and treatment.
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Affiliation(s)
- Flavia da Cunha Vasconcelos
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | - Rodrigo Otavio de Castro Araujo
- Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, INCA, RJ, Brazil; Seção de Cirurgia Abdominal e Pélvica, INCA, RJ, Brazil.
| | - Paula Sabbo Bernardo
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | - Thaís Hancio
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | - Gabriela Nestal de Moraes
- Instituto de Bioquímica Médica Leopoldo de Meis (IBqM), Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | | | | | | | - Raquel Ciuvalschi Maia
- Laboratório de Hemato-Oncologia Celular e Molecular, Programa de Hemato-Oncologia Molecular, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
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Tao Y, Nan Q, Lei Z, Miao YL, Niu JK. Rare primary rectal mucosa-associated lymphoid tissue lymphoma with curative resection by endoscopic submucosal dissection: A case report and review of literature. World J Clin Cases 2022; 10:7599-7608. [PMID: 36158004 PMCID: PMC9353914 DOI: 10.12998/wjcc.v10.i21.7599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/19/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurs in approximately 9% of non-Hodgkin B-cell lymphomas. The gastrointestinal tract is the most commonly affected site of the extranodal forms of primary non-Hodgkin’s lymphomas. However, it rarely occurs within the rectum, and at present, there is no consensus on its diagnosis and treatment at this site.
CASE SUMMARY We report a rare laterally spreading tumour-like rectal MALT lymphoma case in which the diagnosis and the depth of infiltration were determined by magnifying endoscopy and ultrasonic endoscopy. Then, the lesion was en bloc resected by endoscopic submucosal dissection (ESD) alone. The lesion was confirmed as MALT lymphoma by haematoxylin and eosin staining, immunohistochemical staining and gene arrangement analysis. Surveillance exams have indicated a 2-year disease-free survival for this patient.
CONCLUSION We report a rare primary rectal MALT lymphoma that was curable with resection by ESD. ESD is a safe and effective therapeutic option for rectal MALT lymphoma.
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Affiliation(s)
- Yan Tao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Zi Lei
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Ying-Lei Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Jun-Kun Niu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
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Yachida T, Matsuda T, Sakamoto T, Nakajima T, Kakugawa Y, Maeshima AM, Taniguchi H, Kushima R, Tobinai K, Kobara H, Masugata H, Masaki T, Saito Y. Endoscopic features of colorectal lymphoma according to histological type. JGH OPEN 2022; 6:257-262. [PMID: 35475204 PMCID: PMC9021707 DOI: 10.1002/jgh3.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 11/09/2022]
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.
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Affiliation(s)
- Tatsuo Yachida
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
- Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
- Department of General Internal Medicine, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Takahisa Matsuda
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | - Taku Sakamoto
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | - Takeshi Nakajima
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | - Yasuo Kakugawa
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
| | | | - Hirokazu Taniguchi
- Department of Pathology National Cancer Center Hospital Chuo City Tokyo Japan
- Pathology and Clinical Laboratory Division JR Tokyo General Hospital Shibuya City Tokyo Japan
| | - Ryoji Kushima
- Department of Pathology National Cancer Center Hospital Chuo City Tokyo Japan
- Department of Clinical Laboratory Medicine and Diagnostic Pathology Shiga University of Medical Science Otsu Shiga Japan
| | - Kensei Tobinai
- Department of Hematology National Cancer Center Hospital Chuo City Tokyo Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Hisashi Masugata
- Department of General Internal Medicine, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kita‐gun Kagawa Japan
| | - Yutaka Saito
- Endoscopy Division National Cancer Center Hospital Chuo City Tokyo Japan
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Nakrani R, Yeung HM, Arnon M, Selby A, Burgert-Lon C, Kamat B. An unusual presentation of non-IBD related colorectal primary extranodal diffuse large B cell lymphoma with a colo-colonic fistula. J Community Hosp Intern Med Perspect 2021; 11:662-666. [PMID: 34567459 PMCID: PMC8462868 DOI: 10.1080/20009666.2021.1951946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diffuse large B cell lymphoma of the sigmoid colon and rectum is relatively uncommon and aggressive. Due to its nonspecific symptomatology, patients are often diagnosed late into the disease and present with life-threatening complications, such as hemorrhage, obstruction, or perforation, requiring emergent surgical intervention. Patients with colorectal lymphoma typically have inflammatory bowel disease or immunosuppression. We present a case of a 79-year-old male with no known inflammatory bowel disease or immunosuppression, who had significant weight loss, diarrhea, and abdominal fullness, found by CT to have irregular wall thickening of the recto-sigmoid colon along with a colo-colonic fistula, concerning for bowel perforation. Endoscopic evaluation and biopsy confirmed the diagnosis of recto-sigmoid Diffuse large B cell lymphoma, with a PET/CT scan revealing stage IV disease. He had a partial response to six cycles of palliative reduced dose R-CHOP and is currently receiving palliative radiation to the sigmoid colon and rectum. Surgery and/or chemoradiation remain the mainstay therapy for this condition. Clinicians, however, must consider patient’s functional, nutritional, and clinical status prior to choosing an optimal therapeutic regimen. This case illustrates a unique clinical presentation of this condition and the associated diagnostic and therapeutic challenges that arise in order to prevent life-threatening complications.
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Affiliation(s)
- Rima Nakrani
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Ho-Man Yeung
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Matan Arnon
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Alexandra Selby
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | | | - Bhishak Kamat
- Department of Radiology, Temple University Hospital, Philadelphia, PA, USA
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Chen L, Sun Q, Chen E, Jin D, Song Z. Primary colonic lymphoma: report of two cases and a literature review. J Int Med Res 2021; 49:3000605211017037. [PMID: 34082600 PMCID: PMC8182193 DOI: 10.1177/03000605211017037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary colonic lymphoma is a very rare malignant tumor with no standard treatment. We
report two cases of primary colonic lymphoma successfully treated with surgery and
chemotherapy, and chemotherapy alone, respectively. The first case was a 61-year-old woman
who presented with abdominal pain of more than 1 month. The patient was diagnosed with a
colonic tumor, and immunohistochemical examinations confirmed the initial diagnosis of
colonic lymphoma. The patient underwent laparoscopic-assisted right hemicolectomy followed
by postoperative adjuvant chemotherapy with the cyclophosphamide, doxorubicin,
vincristine, and prednisone (CHOP) regimen, combined with targeted therapy with rituximab
(R-CHOP). The second case was a 78-year-old man who presented with a complaint of
abdominal distention for more than 1 year. Diffuse large B-cell lymphoma was definitively
diagnosed by immunohistochemical examinations, and the patient underwent systemic
chemotherapy with the R-CHOP regimen. Primary colonic lymphoma is a rare type of
non-Hodgkin's lymphoma (NHL), and the clinical treatment is not standardized, unlike for
many other types of lymphoma. Therefore, treatment is mainly based on the patient’s
symptoms to determine whether surgery or systemic chemotherapy is appropriate. Rituximab
is effective in some patients and may play an important role in the treatment of
unresectable or asymptomatic colonic lymphoma.
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Affiliation(s)
- Li Chen
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Sun
- Department of Colorectal Surgery, Zhuji People's Hospital of Zhejiang Province, China
| | - Engeng Chen
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongai Jin
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhangfa Song
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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7
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Clinical and pathological characterization of colon lymphomas. Dig Liver Dis 2021; 53:672-674. [PMID: 33509739 DOI: 10.1016/j.dld.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022]
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8
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KAYA T, DEMİRLİ ATICI S, ÇALIK B, GUL G. A Cause of Rectal Mass: Diffuse Large B-Cell Lymphoma. DÜZCE TIP FAKÜLTESI DERGISI 2020. [DOI: 10.18678/dtfd.687478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Hardy AJ, Stoica I, Kearney DE, O'Riordain DS. Diffuse large B-cell lymphoma of the rectum in a patient with Crohn's disease. BMJ Case Rep 2020; 13:13/4/e228818. [PMID: 32303524 DOI: 10.1136/bcr-2018-228818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 62-year-old man presented to our institute with diarrhoea and dysuria on a background of subtotal colectomy and end ileostomy and biological therapy for Crohn's disease. He was diagnosed with urinary tract infection and acute kidney injury (AKI). Renal ultrasound suggested left hydronephrosis, with renal protocol computed tomography (CT) showing a large pelvic mass. Magnetic resonance imaging (MRI) of the pelvis demonstrated a rectal tumour invading the bladder and compressing both ureters. He underwent cystoscopy, flexible sigmoidoscopy and positron emission tomography-CT and was diagnosed with stage IV non-Hodgkin's diffuse large B-cell lymphoma. He was treated primarily with rituximab, cyclophosphamide, hydroxydaunomycin, oncovin and prednisolone chemotherapy regimen. He had ongoing urosepsis before admission for pelvic exenteration. He underwent cystoprostatectomy, excision of rectal stump and formation of ileal conduit. Histology showed no signs of residual malignancy. One year later, the patient was admitted to the intensive care unit with aspiration pneumonia, urosepsis and AKI. Despite maximal therapy, he developed multiorgan failure and passed away.
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Affiliation(s)
- Adam Joseph Hardy
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Dublin, Ireland
| | - Ionica Stoica
- Department of General & Vascular Surgery, Tallaght Hospital, Dublin, Ireland
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Lin C, Lin C, Leong Y, Tung C, Shun C, Wei S, Wong J, Weng M. Ulcerative colitis associated with primary colorectal lymphoma in Taiwan: A tertiary center study. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Cheng‐Lu Lin
- Department of Internal Medicine Far Eastern Memorial Hospital New Taipei City Taiwan
| | - Cheng‐Kuan Lin
- Department of Internal Medicine Far Eastern Memorial Hospital New Taipei City Taiwan
| | - Yew‐Loong Leong
- Department of Internal Medicine West Garden Hospital Taipei Taiwan
| | - Chien‐Chih Tung
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Chia‐Tung Shun
- Department and Graduate Institute of Forensic Medicine College of Medicine, National Taiwan University Taipei Taiwan
| | - Shu‐Chen Wei
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Jau‐Min Wong
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
| | - Meng‐Tzu Weng
- Department of Internal Medicine Far Eastern Memorial Hospital New Taipei City Taiwan
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan
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Abstract
BACKGROUND Primary colorectal lymphoma is rare, representing 0.2% to 0.6% of all colorectal cancers. Because of its low incidence and histologic variety, no treatment guidelines exist. OBJECTIVE The purpose was to report the experience of primary colorectal lymphoma in an institutional and a national cohort. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted with institutional data composed of 3 tertiary referral centers and national data. PATIENTS Patients with primary colorectal lymphoma were identified within the Mayo Clinic (1990-2016) and the Surveillance, Epidemiology, and End Results database (1990-2014). MAIN OUTCOME MEASURES Primary outcomes were overall and 5-year survival. RESULTS For the institutional cohort (N = 82), 5-year survival was 79.9%. Five-year survival was higher for rectal (88.4%) than for colon tumors (77.2%; p = 0.004). On multivariable analysis, age <50 years was associated with higher overall survival (p = 0.04). Left-sided colon masses and aggressive histological subtypes were associated with worse survival (0.04 and 0.03). No effect of treatment modality on survival was noted. For the national cohort (N = 2942), 5-year survival was 58.4%. Five-year survival for rectal tumors was 61.0% and 57.8% for colon tumors. On multivariable analysis, factors associated with improved survival were age <70 y, (p < 0.0001), female sex (p = 0.005), right-sided masses (p = 0.02), and diagnoses after 2000 compared with 1990-1999 (p < 0.0001). Aggressive pathology (p < 0.0001) and stage III or stage IV presentation compared with stage I (p = 0.02 and p < 0.0001) were associated with worse survival. LIMITATIONS The institutional cohort was limited by sample size to describe treatment effect on survival. A major limitation of the national cohort was the ability to describe treatment modalities other than surgery, including chemotherapy and/or no additional treatment. CONCLUSIONS Poorer survival was noted in elderly patients and in those with aggressive pathology. An overall survival advantage was seen in women in the national cohort. Currently, optimal strategies should follow a patient-centered multidisciplinary approach. See Video Abstract at http://links.lww.com/DCR/A807. LINFOMA COLORECTAL PRIMARIO EXPERIENCIA INSTITUCIONAL Y REVISIÓN DE UNA BASE DE DATOS NACIONAL: El linfoma colorectal primario es poco frecuente, representando del 0.2% al 0.6% de todos los cánceres colorectales. Debido a su baja incidencia y variedad histológica, no existen guías de tratamiento. OBJETIVO El propósito fue reportar la experiencia en linfoma colorectal primario en una cohorte institucional y una nacional. DISEÑO:: Este fue un estudio de cohorte retrospectivo. ESCENARIO El estudio se realizó con datos institucionales provenientes de 3 centros de referencia terciarios y datos nacionales. PACIENTES Se identificaron pacientes con linfoma colorectal primario en la base de datos de la Clínica Mayo (1990-2016) y en la base de datos de vigilancia, epidemiología y resultados finales [Surveillance, Epidemiology, and End Results database (1990-2014)]. PRINCIPALES MEDIDAS DE RESULTADO Los resultados primarios fueron la sobrevida general y a 5 años. RESULTADOS Para la cohorte institucional (N = 82), la sobrevida a 5 años fue de 79.9%. La sobrevida a cinco años fue mayor en tumores rectales (88.4%) que en los de colon (77.2%; p = 0.004). En el análisis multivariable, la edad <50 años se asoció con una mayor sobrevida general (p = 0,04). Las masas de colon izquierdo y los subtipos histológicos agresivos se asociaron con una peor sobrevida (0.04 y 0.03). No se observó ningún efecto según la modalidad de tratamiento en la sobrevida. Para la cohorte nacional (N = 2942), la sobrevida a 5 años fue del 58.4%. La sobrevida a cinco años fue de 61.0% para los tumores rectales y 57.8% para los tumores de colon. En el análisis multivariable, los factores asociados con una mayor sobrevida fueron edad <70 años, (p <0.0001), sexo femenino (p = 0.005), masas derechas (p = 0.02) y los casos diagnósticados después del año 2000 comparados con los de 1990-1999 (p <0.0001). Histopatología agresiva (p <0.0001) y presentación en estadio III o estadio IV en comparación con estadio I (p = 0.02 y p <0.0001) se asociaron con una peor sobrevida. LIMITACIONES La cohorte institucional estuvo limitada por el tamaño de la muestra para describir el efecto del tratamiento en la sobrevida. Una limitación mayor en la cohorte nacional fue la habilidad para describir modalidades de tratamiento distintas a la cirugía, incluyendo quimioterapia y/o ningún tratamiento adicional. CONCLUSIONES Una menor sobrevida fue documentada en pacientes de edad avanzada y en aquellos con histopatología agresiva. Se observó ventaja en cuanto a sobrevida general en las mujeres de la cohorte nacional. Actualmente, las estrategias óptimas deben de seguir un abordaje multidisciplinario centrado en cada paciente. Vea el abstract en video en http://links.lww.com/DCR/A807.
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Abstract
BACKGROUND Colon and rectal lymphomas are rare and can occur in the context of posttransplant lymphoproliferative disorder. Evidence-based management guidelines are lacking. OBJECTIVE The purpose of this study was to characterize the presentation, diagnosis, and management of colorectal lymphoma and to identify differences within the transplant population. DESIGN This was a retrospective review of patients evaluated for colorectal lymphoma between 2000 and 2017. Patients were identified through clinical note queries. SETTINGS Four hospitals within a single health system were included. PATIENTS Fifty-two patients (64% men; mean age = 64 y; range, 26-91 y) were identified. No patient had <3 months of follow-up. Eight patients (15%) had posttransplant lymphoproliferative disorder. MAIN OUTCOME MEASURES Overall survival, recurrence, and complications in treatment pathway were measured. RESULTS Most common presentations were rectal bleeding (27%), abdominal pain (23%), and diarrhea (23%). The most common location was the cecum (62%). Most frequent histologies were diffuse large B-cell lymphoma (48%) and mantle cell lymphoma (25%). Posttransplant lymphoproliferative disorder occurred in the cecum (n = 4) and rectum (n = 4). Twenty patients (38%) were managed with chemotherapy; 25 patients (48%) underwent primary resection. Mass lesions had a higher risk of urgent surgical resection (35% vs 8%; p = 0.017). Three patients (15%) treated with chemotherapy presented with perforation requiring emergency surgery. Overall survival was 77 months (range, 25-180 mo). Patients with cecal involvement had longer overall survival (96 vs 26 mo; p = 0.038); immunosuppressed patients had shorter survival (16 vs 96 mo; p = 0.006). Survival in patients treated with surgical management versus chemotherapy was similar (67 vs 105 mo; p = 0.62). LIMITATIONS This was a retrospective chart review, with data limited by the contents of the medical chart. This was a small sample size. CONCLUSIONS Colorectal lymphoma is rare, with variable treatment approaches. Patients with noncecal involvement and chronic immunosuppression had worse overall survival. Patients with mass lesions, particularly cecal masses, are at higher risk to require urgent intervention, and primary resection should be considered. See Video Abstract at http://links.lww.com/DCR/A929.
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13
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Pandey M, Swain J, Iyer HM, Shukla M. Primary lymphoma of the colon: report of two cases and review of literature. World J Surg Oncol 2019; 17:18. [PMID: 30646907 PMCID: PMC6334463 DOI: 10.1186/s12957-018-1548-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Gastrointestinal tract is the most frequent site of extranodal lymphoma accounting for approximately 40% of all extranodal lymphomas; out of these, non-Hodgkin’s lymphoma (NHL) comprises 4% of total cases. Primary lymphoma arising in the colon is very rare comprising only 0.2–1% of all colonic malignancy. Patients and methods We report two cases of 13- and 20-year-old boys with NHL of colon presenting with abdominal pain and weight loss and discuss the approach to colonic lymphoma after a review of world literature to provide an overview on colonic lymphoma. Results Colonic NHL most commonly affects older age group with mean age of diagnosis being 55 years. Abdominal pain and weight loss are the two most common presentations with palpable abdominal mass as physical examination finding in half of the cases. Conclusions Colonic lymphoma in young adolescence is rare. Multimodality approach involving both surgery and chemotherapy is the principal mode of treatment. Radiotherapy is used in selected cases. If diagnosed preoperatively, non-surgical management can be attempted.
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Affiliation(s)
- Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India.
| | - Jyoti Swain
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
| | - Hema Malini Iyer
- Department of Histopathology, Lal Path Labs, New Delhi, India.,Dharamsheela Cancer Centre, Delhi, India
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14
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Cai YB, Chen HY, He JJ, Hu YT, Yang Q, Chen LB, Xiao Q, Ding KF. The role of surgical intervention in primary colorectal lymphoma: A SEER population-based analysis. Oncotarget 2018; 7:72263-72275. [PMID: 27708217 PMCID: PMC5342160 DOI: 10.18632/oncotarget.12344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 08/08/2016] [Indexed: 12/26/2022] Open
Abstract
Background Primary colorectal lymphoma (PCL) is a rare colorectal malignancy. The standard treatment and prognostic factors of PCL remain unexplored. Therefore, a large population-based study should be conducted to provide a detailed review of this disease. Methods We extracted the data of eligible patients with PCL registered in the SEER database from 1973 to 2011. All statistical analyses were performed using SPSS 19.0. Results A total of 2050 (61.3%) of the 3342 patients with PCL underwent surgical intervention, and 1292 (38.7%) patients received no surgical treatment. The median overall survival was 95 months, and patients receiving surgery exhibited significantly prolonged survival (adjusted HR =0.69, P <0.001). Young age, early tumor stage, and indolent lymphoma were independent predictors of improved survival. Further survival analyses demonstrated the potential benefit of surgery in patients with early tumor stage, right-sided lesions, or diffuse large B-cell PCL. Conversely, surgical intervention did not improve the survival of patients with advanced-stage, left-sided, or indolent PCL. Conclusion PCL is a rare tumor that can be effectively treated. Surgical intervention may play an important role in the treatment of PCL. Early tumor stage, a right-sided lesion, and diffuse large B-cell histological PCL seem to be the clinical characteristics of optimal surgical candidates.
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Affiliation(s)
- Yi-Bo Cai
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hai-Yan Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jin-Jie He
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ye-Ting Hu
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qi Yang
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liu-Bo Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Xiao
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ke-Feng Ding
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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15
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Jaime-Andrade E, Lino-Silva LS, Salcedo-Hernández RA, Zepeda-Najar C. Colorectal lymphoma in Mexico: clinico-pathological and survival analysis. J Gastrointest Oncol 2018; 9:90-95. [PMID: 29564175 DOI: 10.21037/jgo.2017.10.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Primary colorectal lymphomas (PCLs) are very rare. We analyze a series of PCL to establish an approximate frequency of the disease and their clinico-pathological characteristics. Methods A retrospective cross-sectional study in a third-level hospital from 2006-2016. Clinico-pathologic features of 18 cases are presented. Results PCL corresponded to 1.5% of malignant colorectal neoplasms. Ten cases presented in men, the median age was 57 years, diffuse large B-cell lymphoma (DLBCL) was the most common subtype (55.6%), 55.6% presented in cecum, 83.4% as unique polypoid tumor and the median size was 52.5 mm. The most prevalent presentation symptom was abdominal pain (61.1%). Six cases (33%) received initial surgery followed by chemotherapy, 7 cases (39%) received only chemotherapy, 2 cases received only surgery and 3 cases no-treatment. The 2-year disease specific survival was 62.7%. The only factors associated with improved survival in univariate analysis were use of surgery followed by chemotherapy (P=0.043) and HIV (P=0.043). On multivariate analysis none factor was an independent risk factor for decreased survival. Conclusions The improved overall survival rates in our series emphasize the importance of surgery followed systemic therapy in the treatment of this disease.
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Affiliation(s)
| | | | | | - César Zepeda-Najar
- Surgical Oncology, Hospital Ángeles Tijuana, Tijuana, Baja California Norte, Mexico
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16
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Won RP, Lin MYC, Williams JL, Petrie BA. Primary Colonic Lymphoma. J Gastrointest Surg 2018; 22:361-362. [PMID: 29188491 DOI: 10.1007/s11605-017-3472-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/07/2017] [Indexed: 01/31/2023]
Abstract
Primary colonic lymphoma is a rare large bowel malignancy usually found in the cecum or rectosigmoid junction. Because of its non-specific symptoms, patients often present with advanced disease requiring surgical intervention. Nevertheless, resection followed by chemotherapy appears to offer the best prognosis.
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Affiliation(s)
- Roy P Won
- Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson St, Box 461, Torrance, CA, 90502, USA.
| | - Matthew Y C Lin
- Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson St, Box 461, Torrance, CA, 90502, USA
| | - Jennifer L Williams
- Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson St, Box 461, Torrance, CA, 90502, USA
| | - Beverley A Petrie
- Department of Surgery, Harbor-UCLA Medical Center, 1000 W. Carson St, Box 461, Torrance, CA, 90502, USA
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17
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18
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Kus T, Aktas G, Kalender ME, Sari I, Ulker E, Camci C. Collision tumor consisting of primary follicular lymphoma and adenocarcinoma in the cecum: A case report and literature review. Oncol Lett 2016; 11:2801-2805. [PMID: 27073555 PMCID: PMC4812099 DOI: 10.3892/ol.2016.4310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/04/2016] [Indexed: 12/18/2022] Open
Abstract
The present study reports the case of a collision tumor consisting of follicular lymphoma (FL) and adenocarcinoma in the cecum of a 73-year-old man. To the best of our knowledge, the present study is the 11th case of a collision tumor consisting of colon adenocarcinoma and lymphoma to be reported in the literature, and the first case of cecum adenocarcinoma with low grade FL in the same segment of the cecum and the same regional lymph node to be reported. The present study reviewed the literature to determine treatment options for patients with collision tumors. The present patient was administered with adjuvant chemotherapy for T3N1M0 colon cancer following surgery, due to the dominance of colon adenocarcinoma in the collision tumor. Following the completion of treatment, progression of the untreated FL was observed. In the literature, patients with collision tumors are administered with chemotherapy for stage IV FL, and following the completion of treatment patients have presented with a recurrence of early stage colon adenocarcinoma. The recommended treatment for collision tumors is dependent on the dominant tumor; however, the treatment options for collision tumors in the literature appeared to exacerbate the other tumor. The characteristics of the tumors altered following chemotherapy, and immunological alterations in the tumors due to chemotherapy appear to have contributed to the exacerbation of the tumors. Therefore, patients with early-stage tumors should be considered at risk of recurrence of other malignancies, which are present in collision tumors.
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Affiliation(s)
- Tulay Kus
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Gokmen Aktas
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Mehmet Emin Kalender
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Ibrahim Sari
- Division of Pathology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Esra Ulker
- Division of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Celaletdin Camci
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
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19
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Lee CU, Glockner JF. MRI of uncommon lesions of the large bowel: a pictorial essay. J Clin Imaging Sci 2014; 4:71. [PMID: 25806129 PMCID: PMC4286819 DOI: 10.4103/2156-7514.148265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/24/2014] [Indexed: 01/11/2023] Open
Abstract
This pictorial essay briefly discusses methods for optimizing bowel imaging with magnetic resonance imaging (MRI) and illustrates the MRI appearance of a variety of unusual lesions involving or related specifically to the large bowel.
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Affiliation(s)
- Christine U Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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