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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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Ulcerative colitis-associated rectal cancer resected and diagnosed by rectovesical fistula: a case report. Clin J Gastroenterol 2021; 14:1163-1168. [PMID: 34170467 DOI: 10.1007/s12328-021-01431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Ulcerative colitis (UC), which mainly consists of mucosal lesions, rarely form colovesical or rectovesical fistulas, although few cases of fistula formation associated with comorbidities have been reported. We report a case of UC-associated rectal cancer diagnosed following symptoms associated with rectovesical fistula. A 40-year-old man with a 31-year history of extensive UC presented with difficulty in defecation. Two years before the current presentation, he had experienced pneumaturia, and the examination then had revealed a rectal neoplastic lesion and rectovesical fistula; however, tissue biopsy showed no malignancy. Therefore, he requested for observation with no further treatment. Current examination suggested the rectal tumor had grown to invade the bladder. Tissue biopsy showed no malignancy. However, the clinical symptoms and examination findings strongly indicated UC-associated rectal cancer with bladder invasion; thus, open total proctocolectomy with partial cystectomy was performed. Histopathological evaluation of the rectal neoplastic lesion revealed UC-associated rectal cancer originating from the inflammatory mucosa, and the rectovesical fistula was found to be caused by the rectal cancer invading the bladder. Therefore, other colorectal cancers should be considered even though tissue biopsy does not reveal malignant lesions in UC patients with fistula.
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Suzuki K, Ohe R, Kabasawa T, Aung NY, Yano M, Katsumi S, Yanagiya R, Yamamoto M, Toubai T, Ishizawa K, Yamakawa M. A case of iatrogenic immunodeficiency-associated colonic lymphoma complicating ulcerative colitis. Diagn Pathol 2020; 15:34. [PMID: 32264892 PMCID: PMC7137478 DOI: 10.1186/s13000-020-00954-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background Ulcerative colitis (UC) is one of the major types of inflammatory bowel diseases and is associated with a significantly increased risk of not only lymphoproliferative disorders but also lymphomas, of which most cases are related to the long-term usage of immunosuppressants. Here, we demonstrate a very rare case of other iatrogenic immunodeficiency-associated colonic diffuse large B-cell lymphoma (Oii-DLBCL) complicating UC and rectal perforation. In addition, we reviewed the clinicopathological features of previous cases of DLBCL related to UC. Case presentation A 68-year-old man was diagnosed with left-sided UC 26 months prior. Although he was followed by immunosuppressive therapy with azathioprine and infliximab, an emergency total proctocolectomy was performed due to rectal perforation. The resected specimen exhibited irregular wall thickening and elevated multinodular lesions extending from the mid-transverse colon to the rectum, measuring up to 52 cm in length. Histologically, the lesion was diagnosed as Oii-DLBCL and crypt abscess surrounded by mixed inflammatory cell was remained. Conclusion Oii-DLBCL complicating UC with rectal perforation is extremely rare. Macro- and microscopic findings are important for early diagnosis of the lesion.
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Affiliation(s)
- Kazushi Suzuki
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Rintaro Ohe
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Takanobu Kabasawa
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Naing Ye Aung
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Mitsuhiro Yano
- Department of Gastroenterological, General, Breast and Thyroid Surgery (First Department of Surgery), Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | - Ryo Yanagiya
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masakazu Yamamoto
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomomi Toubai
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mitsunori Yamakawa
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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