Primary rectal diffuse large B‐cell lymphoma associated with ulcerative colitis: a case report

Hiyama, Kazuhiro; Terashima, Hideo; Nakano, Yoritaka; Kamiga, Masahiro; Harada, K; Horiguchi, Hisashi; Mamiya, Takashi

doi:10.1002/ccr3.185

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…However, the incidence rate of perforations in gastrointestinal lymphoma is approximately 9–22% and is higher than that in high-grade lymphoma (i.e., DLBCL) [ 2 – 4 ]. Primary gastrointestinal lymphoma may decrease the mechanical strength of the gastrointestinal wall and cause intestinal perforation [ 3 , 15 ]. Some studies have found that perforation is a poor prognostic factor in patients with high-grade lymphomas like DLBCL [ 2 – 4 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

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

Suzuki

Iwamoto²,

Nozaki

et al. 2021

BMC Surg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Suzuki

Iwamoto²,

Nozaki

et al. 2021

BMC Surg

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“…We reviewed the clinicopathological data of 11 cases of DLBCL complicating UC published in the English literature, including our case, as shown in Table 1 [1,[3][4][5][6][7][8][9][10][11]. The age at diagnosis ranged from 20 to 73 (median, 55) years.…”

Section: Discussionmentioning

confidence: 99%

“…According to data found in PubMed between 2001 and 2019, only ten cases of diffuse large B-cell lymphoma (DLBCL) complicating UC, including one case of large B-cell lymphoma with unknown details, have been reported [1,[3][4][5][6][7][8][9][10][11]. Approximately half of these cases are closely related to the long-term usage of immunosuppressants (70%, 7/10 cases) and a very high rate of Epstein-Barr virus (EBV) infection (80%, 4/5 cases) and are classified as Oii-LPD.…”

Section: Introductionmentioning

confidence: 99%

A case of iatrogenic immunodeficiency-associated colonic lymphoma complicating ulcerative colitis

et al. 2020

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Background: Ulcerative colitis (UC) is one of the major types of inflammatory bowel diseases and is associated with a significantly increased risk of not only lymphoproliferative disorders but also lymphomas, of which most cases are related to the long-term usage of immunosuppressants. Here, we demonstrate a very rare case of other iatrogenic immunodeficiency-associated colonic diffuse large B-cell lymphoma (Oii-DLBCL) complicating UC and rectal perforation. In addition, we reviewed the clinicopathological features of previous cases of DLBCL related to UC. Case presentation: A 68-year-old man was diagnosed with left-sided UC 26 months prior. Although he was followed by immunosuppressive therapy with azathioprine and infliximab, an emergency total proctocolectomy was performed due to rectal perforation. The resected specimen exhibited irregular wall thickening and elevated multinodular lesions extending from the mid-transverse colon to the rectum, measuring up to 52 cm in length. Histologically, the lesion was diagnosed as Oii-DLBCL and crypt abscess surrounded by mixed inflammatory cell was remained. Conclusion: Oii-DLBCL complicating UC with rectal perforation is extremely rare. Macro-and microscopic findings are important for early diagnosis of the lesion.

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“…Although overall similarities were apparent between the 2 cases with respect to the clinical spectrum of the diseases, notable differences included the presence of both EBV-positive lymphocytes and previous exposure to immunomodulatory agents in the reported case. 10 This suggests that perhaps there are other underlying mechanisms that predispose the UC patient to NHL. One theory is that chronic colorectal inflammation leads to overstimulation of the immune system and proliferation of immune cells.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Large B-Cell Lymphoma Mimicking an Ulcerative Colitis Flare

et al. 2019

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We present a case of non-Hodgkin lymphoma of the rectum in a 41-year-old African American male with a 1 year history of ulcerative colitis and no previous immunomodulatory therapy. The patient presented with a 10-day history of hematochezia, for which endoscopy was performed with gross findings indicative of ulcerative colitis flare. Tissue biopsy, however, demonstrated significant lymphoid infiltrating regions with histologic findings suggestive of a diffuse large B-cell lymphoma. Non-Hodgkin's lymphoma accounts for less than 1% of all cases of colorectal cancer. Associated risk factors have been previously reported but, were absent in the patient’s history. This suggests the possibility of distinct genetic abnormalities inherent to the tumor and/or an underlying germline mutation inherent to the patient that may have contributed to the premature development of diffuse large B-cell lymphoma.

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Primary rectal diffuse large B‐cell lymphoma associated with ulcerative colitis: a case report

Cited by 9 publications

References 24 publications

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

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

A case of iatrogenic immunodeficiency-associated colonic lymphoma complicating ulcerative colitis

Diffuse Large B-Cell Lymphoma Mimicking an Ulcerative Colitis Flare

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