Unusual Lymphoma Found on Routine ColonoscopyWhat's Hiding in Your Colon?
Heather Gerst, DO, Stacy Prall, DO and Martha Ghosh, MD Gastroenterology- Geisinger Medical Center
Introduction
Primary malignant lymphoma of the large intestine is rather rare Accounts for only 0.2% of primary neoplasms of the large intestine Intestinal marginal zone B-Cell lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT) type is equally rare We present a case of MALT lymphoma involving only the colon
Case Report
57 year old female presented to her primary care physician's office for a routine health exam Review of systems negative for weight loss, fatigue, chills, night sweats, hematochezia or alteration in bowel function Physical exam was remarkable for a rectal polyp palpable on digital rectal exam Stool was hemoccult negative Laboratory studies revealed normal CBC, creatinine, calcium and hepatic function
Patient underwent colonoscopy which revealed a five mm rectal polyp and a 4 cm frond-like villous mass at 60 cm The rectal polyp was hyperplastic The mass histologically demonstrated lymphoma features and subsequent hemicolectomy was performed Surgical specimen was consistent with extranodal marginal zone B-Cell lymphoma of MALT type
Image
1 Frond-like villous mass in transverse colon
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2 Lymphoepithelial lesions with reactive lymphoid follicles.
Discussion
MZL accounts for approximately 8% of all NHL Stomach is the most common site of MZL of MALT type Ileum is the most common small bowel site MALT lymphomas of the large bowel most commonly effect the rectum Clinically -typically indolent, remaining localized for prolonged periods When found-usually accompanies symptoms, requires surgical excision and depending on grade of lymphoma may require conjunctive chemotherapy (Rituximab)
Discussion
This case represents an unusual finding on a routine colonoscopy in an asymptomatic patient Our patient is unique in that she does not have any other evidence of NHL in the presence of an isolated colonic MZL of MALT type She continues to do well after resection and has finished conjunctive chemotherapy Repeat CT scans show no evidence of NHL
Thank You
Albert Quiery Jr., MD - Department of Hematology/Oncology Mary Xiahaong Zhang, MD Department of Pathology Stacy Prall, DO - Department of Gastroenterology
References
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Saito T, Toyoda H, Yamaguchi M, Nakamura T, Nakamura S, Mukai K, Fuke H, Wakita Y, Iwata M, Adachi Y, Shiku H. Ileocolonic lymphomas: a series of 16 cases. Endoscopy 2005: May; 37 (5) : 466-9.
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