Primary colonic lymphoma: An incidental finding in a patient with a gallstone attack

Abstract

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound (US) and total body computed tomography (CT) exams that allowed us to make the correct final diagnosis. A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant, spreaded to the right shoulder blade. Patient had nausea and mild fever and Murphy's maneuver was positive. At physical examination a large bulky mass was found in the right flank. Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspondence of the palpable mass, an extended concentric thickening of the colic wall. CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum. In addition, revealed signs of microperforation of the colic wall. Numerous large lymphadenopathies were found in the abdominal, pelvic and thoracic cavity and there was a condition of splenomegaly, with some ischemic outcomes in the context of the spleen. No metastasis in the parenchimatous organs were found. These imaging findings suggest us the diagnosis of lymphoma. Patient underwent to surgery, and right hemicolectomy and cholecystectomy was performed. Histological examination confirmed our diagnosis, revealing a diffuse large B-cell lymphoma. The patient underwent to Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone chemotherapy showing only a partial regression of the lymphadenopathies, being in advanced stage at the time of diagnosis.

Primary Colorectal Diffuse Large B-cell Lymphoma: a Report of Eighteen Cases in a Tertiary Care Center

“…An interesting case was reported by Gigli and colleagues regarding an incidental DLBCL diagnosis in an 85years-old male patient with symptoms of gallstone attack 27 . This patient referred abdominal pain and loss of appetite.…”

Unusual presentation of aggressive high‐grade B‐cell lymphoma of colonic origin: A case report and review of the literature

“…In these cases, surgery is often preferred in order to avoid complications and particularly the risk of perforation. The rate of spontaneous perforation in patients with colorectal lymphoma is 5%–11.5% 14 . In large lesions, surgical intervention may decrease rates of post‐chemotherapy perforation and bleeding.…”

“…The rate of spontaneous perforation in patients with colorectal lymphoma is 5%–11.5%. 14 In large lesions, surgical intervention may decrease rates of post‐chemotherapy perforation and bleeding. It may also increase long‐term remission rates over chemotherapy alone.…”