Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy

Abstract

The gastrointestinal tract is the most common site of extra-nodal non-Hodgkin lymphoma. However, the incidence of primary rectal lymphoma is extremely rare. Among the primary gastrointestinal lymphomas, follicular lymphoma has been described as a rare disease. It is difficult to diagnose rectal lymphoma due to its variable growth patterns and inadequate biopsies. Majority of patients with rectal lymphoma have non-specific symptoms or negative biopsies, often delaying the diagnosis. Our patient is a 62-year-old female. Two sessile and smooth subepithelial lesions with a yellowish normal mucosa were found on a screening colonoscopy. The initial mucosal biopsy finding was chronic inflammation, but we were highly suspicion of malignancy; we performed an endoscopic mucosal resection. Herein, we present a rare case of rectal follicular lymphoma diagnosed by endoscopic mucosal resection with a literature review.

Primary Colonic Follicular Lymphoma Presenting as Four Diminutive Sessile Polyps Found Incidentally During Colonoscopy

“…Our patient’s tumor was diagnosed as stage IIIA owing to lymph node involvement in the left side of the neck, which was confirmed by excisional biopsy. Notably, previously published Korean cases did not report any infiltration of the liver, spleen, bone marrow, or lymph nodes as compared with our case [ 12 , 13 ].…”

“…One study on patients with primary intestinal follicular lymphoma revealed that the most frequent site was the second portion of the duodenum (81%) followed by the jejunum (40%), whereas the rate of colon involvement was just 1% [ 11 ]. In addition, there are few reports on colorectal follicular lymphoma in Korea [ 12 , 13 ]. The most common symptoms of colorectal lymphoma are abdominal pain, changes in bowel habits, GI bleeding, and the presence of an abdominal mass; in particular, abdominal pain is more common for B-cell lymphoma, including follicular lymphoma [ 5 ].…”

“…The most common symptoms of colorectal lymphoma are abdominal pain, changes in bowel habits, GI bleeding, and the presence of an abdominal mass; in particular, abdominal pain is more common for B-cell lymphoma, including follicular lymphoma [ 5 ]. However, several cases have been discovered during screening without specific symptoms [ 9 , 12 ]. Our patient had no symptoms, and the lesions were found by chance during colonoscopic surveillance.…”

“…There are only two reports of primary colorectal follicular lymphoma in Korea; one case showed two polyps less than 4 mm in size that were sub-epithelial lesions, whereas the other case showed multiple 10−20-mm mucosal elevated lesions. Both of those previous cases were located in the rectum and not the colon [ 12 , 13 ].…”

Case report: Coexistence of rectal signet ring cell carcinoma with neuroendocrine components

“…Most patients with colorectal lymphoma have non-typical symptoms or negative biopsies [18] . Thus, as such tumor has a special feature of intramural growth and is often difficult to differentiate from inflammatory processes [17,19] comprehensive assessment of diagnostic methods and timely surgical intervention are necessary to avoid misdiagnosis or delaying treatment.…”