Coexistence of primary colorectal follicular lymphoma and multiple myeloma: a case report

Abstract

Colorectal follicular lymphoma (FL) occurs less frequently than duodenal-type FL, which is an established entity, and primary multiple FL only involving the colon is rare. Furthermore, the coexistence of lymphoma and multiple myeloma (MM) within the same patient is rare and the current study reports such a case. The patient was an asymptomatic 62-year-old man. He underwent colonoscopy screening, which revealed at least five polypoid tumors from the cecum to the rectum. Biopsy samples stained positive for CD20 and B-cell lymphoma 2 (BCL2) but stained negative for CD10, and fluorescence in situ hybridization analysis identified IGH/BCL2 in 95.2% of the tumor cells. Based on these findings, the patient was diagnosed with FL. On the bone marrow aspirate, the plasma cell count was 30% of all nucleated cells. Bence-Jones κ-type protein was detected by protein electrophoresis in serum and urine. The serum-free light chain κ/λ level was significantly elevated (484.3). Thus, the patient was also diagnosed with MM. Both FL and MM were targeted therapeutically; rituximab and bendamustine were effective for FL, and lenalidomide and low-dose dexamethasone were effective for MM. The patient was treated for 3 years and 7 months and, until now, was off-treatment for 4 years without rapid progression of the two malignancies. Although both diseases are still present, the patient has maintained stable disease. Our findings suggest that lymphoma and MM should be targeted separately as independent hematological malignancies when they occur concurrently.

A Rare Case of BCL2-Positive Multiple Myeloma Complicated with Follicular Lymphoma

“…On the other hand, only one case of FL has been reported. The reason for the merging with MM is unknown; i.e., it is unknown whether it is derived from FL, and it is unknown whether activated CD4 T-cells were involved [ 4 ].…”

“…The effectiveness of venetoclax, however, was limited in the treatment of follicular lymphoma [ 16 , 17 ]. In a report of FL complicated with MM, rituximab and bendamustine were administered for the treatment of FL, followed by lenalidomide and dexamethasone for the treatment of MM [ 4 ]. Although the BCL2 protein was not analyzed, lenalidomide was a useful treatment option for both FL and MM [ 17 ].…”

“…Reports of multiple myeloma (MM) merged with malignant lymphoma (ML) are rare [1][2][3], and reports of MM merged with follicular lymphoma (FL) are even rarer [4].…”

Primary Colorectal Follicular Lymphoma Observed by Magnifying Endoscopy, with a Five-year Follow-up

“…The median age was 65.8 (range: 56-75) years old, and the male-to-female ratio was 4:4. According to the Lugano classification, the ratio of clinical stages I:II1 was 6: 2 and the endoscopic appearances of papular, polypoid and flat elevated type were observed in 4, 2 and 2cases, respectively (7)(8)(9)(10)(11)(12)(13)(14), and all of which showed raised lesions (Table). Nakamura et al reported that the endoscopic features of intestinal lymphoma may be classified as polypoid, ulcerative, multiple lymphomatous polyposis (MLP), diffuse, and mixed type (15).…”

Coexistence of nodal marginal zone B-cell lymphoma and multiple myeloma

“…B-cell lymphoma and MM rarely occur simultaneously or in succession. We reviewed similar cases from the PubMed database and found that the types of B-cell lymphoma coexisting with MM were Hodgkin's lymphoma, [ 12 , 13 ] chronic lymphocytic leukemia/small lymphocytic lymphoma, [ 14 , 15 ] diffuse large B-cell lymphoma, [ 16 ] follicular lymphoma [ 17 ] and mantle cell lymphoma. [ 18 ] The most common type was chronic lymphocytic leukemia/small lymphocytic lymphoma.…”