Primary non-Hodgkin lymphoma of the small bowel

Primary colonic lymphoma: report of two cases and a literature review

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.

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Colon: A Case Report and a Literature Review

Patient: Female, 56

Final Diagnosis: Colonic MALT lymphoma

Symptoms: Epigastric pain

Medication: —

Clinical Procedure: Colonoscopy and biopsy

Specialty: Gastroenterology and Hepatology

Recurrence patterns of mucose-associated lymphoid tissue lymphoma after definitive radiation treatment: A single center experience

OBJECTIVES

To evaluate the treatment outcomes in non-gastric and non-nodal mucose-associated lymphoid tissue (MALT) lymphoma patients treated by definitive radiation therapy (RT).

METHODS

A total of 134 patients were analyzed. The RT dose was 30.6 or 36 Gy.

RESULTS

The median follow-up duration for all patients was 51.1 months (range, 3.0-132.4 months). Among the 88 orbital MALT lymphoma patients, 12 had disease recurrence. There were 23 head and neck tumor patients. Two patients experienced relapse, all at out-of-field locations. Gastrointestinal MALT lymphoma was diagnosed in 13 patients, and three showed local (n = 1), distant (n = 1), or local/distant (n = 1) relapse.

CONCLUSION

RT alone is highly effective in achieving local control and long-term survival in localized MALT lymphoma. In orbital MALT, excellent local control is achieved, and relapse is predominantly observed in the contralateral eye. Other head and neck lymphomas are also well controlled.

Intussusception of a small bowel large B-cell lymphoma

Gastrointestinal tumors can rarely cause intestinal intussusception. Herein, we describe a 74 year-old male with a presumed diagnosis of Crohn's disease who presented with persistent symptoms refractory to medical management. Radiography demonstrated small bowel intussusception into the cecum. Lower endoscopy with biopsy diagnosed small bowel large Bcell lymphoma. Management included laparoscopic ileocecectomy and adjuvant R-CHOP chemotherapy. Long term outcomes of small bowel large B-cell lymphoma are related to disease stage at diagnosis, and average close to 75 %.

Non-Hodgkin's lymphoma involving the ileocecal region: a single-institution analysis of 46 cases in a Chinese population

BACKGROUND AND GOALS

Non-Hodgkin's lymphoma (NHL) involving the ileocecal region is a rare occurrence. Optimal management and treatment outcomes of ileocecal NHL have not been well defined.

STUDY

In this study, clinical characteristics, treatment outcomes, and prognostic factors of 46 Chinese patients with ileocecal NHL were retrospectively analyzed.

RESULTS

Among 46 patients, the median age of these patients was 46 years and 84.8% of them were male. Twenty-four cases (52.2%) had early-stage disease (stage I/II1/II2) and 35 (76.1%) cases were of B-cell origin. Higher incidence of fever (P=0.001) and intestinal perforation (P=0.038) at onset was observed in T-cell lymphomas. Surgical emergencies occurred in 13 patients, including 8 patients who were receiving chemotherapy. Patients with T-cell advanced ileocecal NHL (stage IIE/IV) suffered more surgical emergencies during chemotherapy than others (P=0.005). The 5-year overall survival and progression-free survival rates for these 46 patients were 64.2% and 49.3%, respectively. Early-stage cases undergoing radical resection before chemotherapy had a prolonged 5-year progression-free survival rate (P=0.01). In multivariate analysis, both advanced stage and T-cell phenotype were identified as independent prognostic factors for poor survival.

CONCLUSIONS

Radical resection before chemotherapy should be considered in early-stage ileocecal NHL to achieve a better survival. Palliative resection of the primary lesion before chemotherapy may be necessary in T-cell advanced cases to avoid surgical emergencies during chemotherapy. Owing to the small sample number in this study, a prospective analysis with larger sample number is highly necessary.

Role of radiotherapy in the treatment of lymphomas of the gastrointestinal tract

In patients with gastrointestinal lymphoma the most frequently involved site is the stomach (60%-75% of cases), followed by the small bowel, ileum, cecum, colon and rectum. The most common histological subtypes are extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphoma (DLBCL). The role of radiotherapy is most definite in early stage gastric lymphoma. The therapeutic approach for patients with gastric Non Hodgkin lymphoma (NHL) has changed significantly over the last decades. The primary treatment of limited gastric MALT lymphoma consists of Helicobacter pylori eradication. In case of insufficient response to H. pylori eradication or in case H. pylori is absent, irradiation of the stomach and perigastric lymph nodes to a dose of 30-40Gy in 15-20 fractions is indicated. In patients with gastric DLBCL conservative treatment with anthracycline-based chemotherapy alone or in combination with involved-field radiotherapy has become the therapy of choice.

Primary small-bowel non-Hodgkin's lymphoma: a study of clinical features, pathology, management and prognosis

The records of 34 patients diagnosed with primary small bowel non-Hodgkin's lymphoma during a 10-year period between January 1996 and December 2005, including 27 cases for which complete follow-up records were available, were studied. Abdominal pain (70.6% of patients) was the main presenting symptom, followed by intestinal obstruction (38.2%). The most common primary site was the ileum (58.8%), followed by the jejunum (26.5%) and duodenum (17.6%); one case had tumours at two sites in the small bowel. Twenty-seven patients had small bowel B-cell lymphoma (24 diffuse large B-cell lymphoma; three mucosa-associated lymphoid tissue B-cell lymphoma) and seven patients had small bowel T-cell lymphoma. Cumulative survival in patients with small bowel B-cell lymphoma was higher than that in patients with small bowel T-cell lymphoma. Data on 16 male and eight female patients with diffuse large B-cell lymphoma showed that 62.5% of these patients presented with disease stages I or II and 37.5% with stages III or IV. Cumulative survival in patients at stages IE or IIE was significantly higher than that of patients at stages IIIE or IVE. Four of five patients who died from diffuse large B-cell lymphoma had abnormal levels of lactate dehydrogenase and serum albumin.

[Primary small bowel lymphoma]

We present four patients with non-Hodgkin's lymphoma of the small bowel. Three of the patients were men. Two patients presented with acute abdomen due to tumoral perforation and the remaining 2 presented with abdominal pain and other effects of the mass. The tumors were located in the ileum (1 patient), jejunum (2 patients) and jejunoileum (1 patient). All patients underwent resection of the affected segment. Three patients had large B-cell lymphomas and the remaining patient had a T-cell lymphoma associated with celiac disease. Different combinations of chemotherapy were administered. Only the patient with T-cell lymphoma died due to disease progression. Clinical aspects and the therapeutic strategy used in these tumors are discussed.

Primary extranodal lymphomas of gastrointestinal localizations: a single institution 5-yr experience

This study is aimed at comparison of patients with extranodal lymphomas based on pathohistological findings differences (MALT vs non-MALT) as well as regarding gastric and non-gastric localization, and determining the significance of clinical-laboratory parameters with respect to therapeutic response and length of survival. A total of 56 patients with extranodal non-Hodgkin's lymphomas of the gastrointestinal tract were evaluated over a 5-yr period. Regarding the localization of the disease, the stomach was most frequently affected, 39 patients (70%); followed by small and large intestines, 17 patients. As for the pathohistological findings, MALT lymphoma accounted for 70%, DLBCL 25%, while other subtypes accounted for 5%. Patients' distribution was analyzed according to CS based on both Ann Arbor and Lugano systems; however, the difference obtained between the groups was not statistically significant in both staging types of patients. Statistically significant difference in patients' distribution was not found with respect to IPI index, bone marrow infiltration, anemia, hypoalbuminemia, or histological subtype and localization. Difference in survival between patients according to the pathohistological type was not statistically significant also according to the type of the affected gastrointestinal tract organ. Statistical significance of difference according to survival probability was obtained based on age (survival is longer in patients over 55 yr of age); according to CS and according to Ann Arbor and Lugano classifications (the patients with lower CS live significantly longer); according to IPI index (the survival is significantly longer in patients with lower probability: IPI-0,1, and 2), as well as patients free of bone marrow infiltration whose survival is also significantly longer.

Intestinal non-Hodgkin's lymphoma: a multicenter prospective clinical study from the German Study Group on Intestinal non-Hodgkin's Lymphoma

PURPOSE

Intestinal non-Hodgkin's lymphomas are not well characterized. We therefore studied prospectively their clinical features and response to standardized therapy.

PATIENTS AND METHODS

Fifty-six patients with primary intestinal lymphoma were included in a prospective, nonrandomized multicenter study. Lymphoma resection was recommended and staging was performed according to the Ann Arbor classification. Patients were scheduled to receive six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy, and at stages EIII to EIV, they received additional involved-field radiotherapy. Corticosteroids were used in patients who could not receive chemotherapy.

RESULTS

Thirty-five patients had intestinal T-cell lymphoma (ITCL), 21 patients had intestinal B-cell lymphoma (IBCL; 18 diffuse large-cell lymphomas, two marginal-cell lymphomas, and one follicle-center lymphoma). Thirty-four patients at stages EI to EII (14 ITCL and 20 IBCL) and nine patients at stages EIII to EIV (all ITCL) received chemotherapy. No patient in stages EIII to EIV received radiotherapy, because death occurred in 12 of 14 patients. Two-year cumulative survival in patients with IBCL was 94% (95% CI, 82% to 100%) and higher than in patients with ITCL (28% [95% CI, 13% to 43%]; P <.0001), even when only stages EI to EII were considered (ITCL, 37.5% [95% CI, 16.5% to 58.5%]; P <.0001). IBCL patients compared with ITCL patients were at lower lymphoma stages (P <.01), had higher Karnofsky status (P <.005), had intestinal perforation less often (P <.05), required emergency operation less often (P <.05), received CHOP (P <.05) more often, and reached complete remission (P <.0005) more frequently.

CONCLUSION

IBCL patients at stages EI and EII respond well to chemotherapy, but the prognosis and treatment of ITCL patients is unsatisfactory.