Primary colorectal T-cell lymphoma

Abstract

We report here a case of primary colorectal T-cell lymphoma in a 49-year-old man. Eighteen years previously, he was diagnosed as having ulcerative colitis based on the findings of colonoscopy and a barium enema. Since then, he had been treated with salicylazosulfapyridine until the most recent episode. He was refered to our clinic with the chief complaint of abdominal pain and excretion of mucus, and for a workup of bowel lesions. Physical examination results were not remarkable, except for the presence of low-grade fever. Total colonoscopy showed multiple shallow ulcers and aphthoid erosions through the entire colon and rectum, except for the descending colon. Endoscopic findings of the descending colon were normal, which was different from the findings of the active stage of ulcerative colitis. Biopsy specimens from the colon and rectum with ulcerations and aphthoid erosions showed a diffuse proliferation of medium-sized to large atypical lymphoid cells with irregular and indistinct nucleoli, thus revealing malignant lymphoma, diffuse pleomorphic type. The lymphoma cells were positive for CD2, CD3, CD5, CD8, and T-cell receptor (TCR) beta F1, but negative for CD4, CD19, CD20, CD103, and CD56. Southern blotting revealed rearrangement of TCR. Based on these findings, the patient was diagnosed as having high-grade T-cell lymphoma. The findings of computerized tomography of the chest and abdomen, gallium scintigraphy, and abdominal ultrasonography were all normal. There were no abdominal lesions throughout the esophagus, stomach, duodenum, and small intestine. As the patient refused total proctocolectomy, he was treated with one course of CHOP (cyclophosphamide, vincristine, adriamycin, and prednisolone) and subsequently with three courses of ProMACE-CytaBOM (consisting of cyclophosphamide, adriamycin, etoposide, cytarabine, bleomycin, vincristine, methotrexate, and prednisolone). After the therapy, improvement of the colorectal lesions was observed, though lesions clearly still remained. To our knowledge, this is the first case report of primary colorectal T-cell lymphoma with cytotoxic/suppressor T-cell phenotype.

Primary CD56+ NK/T-cell lymphoma of the rectum accompanied with refractory ulcerative colitis

“…6,23 Previous reports have shown that intestinal lymphoma tends to arise from areas exposed to intense and long-standing infl ammation, such as the rectum. 28,29 In fact, an analysis of 21 cases of malignant lymphoma in UC patients conducted by Abulafi et al 30 revealed that 52.4% of the lymphomas originated in the rectum, compared to the 60% that develop in the cecum in isolated intestinal lymphoma cases. In the present case, the patient had a 6-year history of repeated hospital admis- sion for UC, and the lymphoma developed in the rectum, which had undergone severe infl ammation and displayed refractoriness.…”

Primary rectal lymphoma: an unusual treatment for a rare case

“…This differentiation is made by using cluster of differentiation antibodies (CD): CD3, CD4, CD7 and CD8 are determined in T cell lymphomas; CD10, CD19 and CD20 are determined in B cell lymphomas 11. In our patient, no staining was observed with CD3, whereas staining was observed with CD20.…”

“…The reported average survival rate is 24 months 2. There are different results for the impact of adjuvant chemotherapy and radiotherapy on survival 2 11 13. Although it is accepted that adjuvant treatment is necessary, there is still no consensus because of the small number of cases.…”

Colorectal Lymphoma

“…10 T-cell lymphoma and Hodgkin's lymphoma affecting the colon have been described but are rare. 11 Lymphomas are generally staged according to the number and sites of nodal and extranodal involvement, and multiple staging schemes have been described. The Ann Arbor staging system modified by Musshoff is widely used in clinical practice today 12 (see Table 2).…”