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Unusual Lymphoma Found on Routine Colonoscopy What's Hiding in Your Colon

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Patient underwent colonoscopy which revealed a five mm rectal polyp and a 4 cm ... an unusual finding on a routine colonoscopy in an asymptomatic patient ... – PowerPoint PPT presentation

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Title: Unusual Lymphoma Found on Routine Colonoscopy What's Hiding in Your Colon


1
Unusual Lymphoma Found on Routine Colonoscopy-
What's Hiding in Your Colon? 
  • Heather Gerst, DO,  Stacy Prall, DO and Martha
    Ghosh, MD
  • Gastroenterology- Geisinger Medical Center

2
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

3
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

4
  • 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

5
  • Image 1 Frond-like villous mass in transverse
    colon

6
  • Image 2 Lymphoepithelial lesions with reactive
    lymphoid follicles.

7
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)

8
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

9
Thank You
  • Albert Quiery Jr., MD - Department of
    Hematology/Oncology
  • Mary Xiahaong Zhang, MD - Department of
    Pathology
  • Stacy Prall, DO - Department of Gastroenterology

10
References
  • Tedeschi L, Romanelli A, Dallavalle G, Tavani E,
    Arnoldi E, Vinci M, Mortara G, Bedoni P, Labianca
    R, Luporini G.  Stages I and II non-Hodgkin's
    Lymphoma of the gastrointestinal tract. 
    Retrospective analysis of 79 patients and review
    of the literature.  J Clin Gastroenterology 1994
    Mar 18 (2)99-104.
  •   
  • Koh PK, Horsman JM, Radstone CR, Hancock H,
    Goepel JR, Hancock BW.  Localized extranodal
    non-Hodgkin's lymphoma of the gastrointestinal
    tract Sheffield Lymphoma Group experience
    (1989-1998).  Int J Oncol 2001 Apr 18 (4)
    743-8.
  •  
  • Ahlawat S, Haddad N, Kanber Y, Cohen P, Ozdemirli
    M, Benjamin S.  Primary mucosa-associated
    lymphoid tissue lymphoma occurring in the
    rectum.  Gastrointestinal Endoscopy 2005
    September Vol 62, Issue 3 443-444.
  •  
  • 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.

11
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