Diffuse large B-cell lymphoma originating from the rectum and diagnosed after rectal perforation during the treatment of ulcerative colitis: a case report

Abstract

Background Gastrointestinal lymphomas like diffuse large B-cell lymphoma (DLBCL) are rare complications of ulcerative colitis (UC), and only a few studies have reported intestinal ulcers caused by DLBCL, which got perforated during the treatment of UC. Case presentation A 43-year-old man with severe lower abdominal pain and an 8-year history of UC was admitted in our hospital. He was diagnosed UC since 8 years and received a maintenance oral dose of 5-aminosalicylic acid, and no other immunosuppressive drugs. A deep rectal ulcer was endoscopically diagnosed 10 months before admission, no malignancy or cytomegalovirus infection was detected on biopsy. After 7 months a further endoscopy with biopsies confirmed the finding and the absence of malignancy. Three months later the patient developed sudden abdominal pain and was admitted in our hospital. Rectal perforation was suspected on X-ray and computed tomography imaging, and an emergency surgery was performed. Surgical exploration revealed a perforation on the anterior wall of the rectum. A subtotal colectomy with temporary ileostomy was performed. Pathology examinations showed lymphocyte infiltration of all of the layers of the perforated site and an immunohistochemical evaluation revealed DLBCL. Clinical staging was stage IV, and the patient received a 6-months regimen of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Positron emission tomography restaging revealed disappearance of distant uptake and a slight uptake in the residual rectum, and completion proctectomy with ileal pouch-anal anastomosis was performed. No residual tumor in the specimen was found, and the patient was disease-free at 2 years follow-up. Conclusions DLBCL may increase the frequency of perforation and is a poor prognostic risk factor for patients with UC. This case study emphasizes the importance of careful medical surveillance and repeated endoscopic biopsies during the treatment of UC.

Perforated small bowel lymphoma: a rare presentation of Crohn’s disease

“…The perforation rate in gastrointestinal lymphoma is about 9%–22%, exceeding the rate observed in high-grade lymphomas such as DLBCL [ 7 ]. DLBCL represents a fast-growing B-cell lymphoma, histologically identified by the widespread growth of large cancerous B lymphoid cells whose nucleus size matches or surpasses the nuclei of typical histiocytes [ 8 ].…”

“…Primary gastrointestinal lymphoma can lead to a reduction in the mechanical integrity of the gastrointestinal wall, potentially resulting in intestinal perforation [ 7 ]. Several studies have indicated that perforation is an unfavorable prognostic indicator for individuals with high-grade lymphomas such as DLBCL [ 3 ].…”

Primary Diffuse Large B-Cell Lymphoma of the Rectum in a Non-Immunosuppressed Patient with Ulcerative Colitis

“…In the present case, however, primary rectal DLBCL developed in the absence of previous or current immunomodulatory therapy for the treatment of UC. Although being extremely rare, similar cases have been reported in the literature [10, 12, 13], raising the hypothesis of alternative mechanisms contributing to the development of DLBCL in UC patients [10]. One of the possible mechanisms is overstimulation of the immune system secondary to chronic colorectal inflammation.…”