Title: Splenic Flexure Diffuse Large B Cell Lymphoma With Bowel Obstruction: A Radio Pathological Correlation
Authors: Abhishek Dwivedi, P K Dhagat, Kasi Viswanathan M, S N Singh, Shalini Singh
DOI: https://dx.doi.org/10.18535/jmscr/v4i11.09
Background: The colorectal lymphoma encountered rarely among the colonic malignancies. Early diagnosis is often challenging because of non specific symptoms, with subsequent delays in diagnosis and management. We describe a rare case of large B cell lymphoma of splenic flexure with associated obstruction. Case Presentation: A 73-year-old male with a 6 days history of vague abdominal pain, constipation and melena was referred to our hospital. Computed tomography scan of abdomen revealed the presence of a thickened bowel loop with stricture along the splenic flexure and large descending bowel displacement medially with adhesion. Because of the acute obstruction with poor clinical condition the patient underwent left hemicolectomy, proximal colostomy and distal mucous fistula formation. The surgically resected splenic flexure was all pathologically and immunohistochemically diagnosed as diffuse large B-cell lymphomas (DLBCL). The patientis was on advance life support and ventilatory support and died 15 days after the surgery by multiple organ dysfunction syndromes. Conclusions: Primary colonic lymphomas represent a rare minority among the colonic neoplasm’s and if not correctly diagnosed can have poor outcome. This case highlights the difficulty in diagnosing of primary colonic lymphoma at splenic flexure. Keywords: Mucous fistula, primary colonic lymphoma, Adenocarcinoma. 1. Mahfoud T et al : a case report and literature review. J Gastrointest Cancer 2012, 43(4):619– 21. 2. Daum S, Ullrich R, Heise W et al: Intestinal non-Hodgkin’s lymphoma: a multicenter prospective clinical study from the German Study Group on Intestinal non-Hodgkin’s Lymphoma. J Clin Oncol 2003, 21(14):2740–2746. 3. Doolabh N, Anthony T, Simmang C, Bieligk S et al J Surg Oncol 2000, 74:257–262 4. Fisher RI, Oken MM: Clinical practice guidelines: non-Hodgkin’s. lymphomas. Cleve Clin J Med 1995, 62(Suppl 1): SI6e42. SI43e45. 5. Sciaudone G, Pellino G, Selvaggi F: Diagnostic pitfalls: cancerization in IBD versus mantle cell lymphoma presenting with multiple lymphomatous polyposis. Inflamm Bowel Dis 2011, 17(6):E28–E30. 6. Wang MH, Wong JM, Lien HC, Lin CW, Wang CY: Colonoscopic manifestations of primary colorectal lymphoma. Endoscopy 2001, 33(7):605–609. 7. Wyatt SH, Fishman EK, Jones B: Primary lymphoma of the colon and rectum: CT and barium enema correlation. Abdom Imaging 1993, 18(4):376–380. 8. Myung SJ, Joo KR, Yang SK, Jung HY et al: Clinicopathologic features of ileocolonic malignant lymphoma: analysis according to colonoscopic Classifictaion. Gastrointest Endosc 2003, 57(3):343–347. 9. Bruneton JN, Thyss A, Bourry J, Bidoli R, Schneider M: Colonic and rectal lymphomas: a report of six cases and review of the literature. Rofo 1983, 138(3):283–287. 10. O’Connell DJ, Thompson AJ: Lymphoma of the colon: the spectrum of radiologic changes. Gastrointest Radiol 1978, 2:377–385. 11. Dawson IM, Cornes JS, Morson BC: Primary malignant lymphoid tumours of the intestinal tract: report of 37 cases with a study of factors influencing prognosis. Br J Surg 1961, 49:80–89. 12. Bairey O, Ruchlemer R, Shpilberg O: Non- Hodgkin’s lymphomas of the colon. Isr Med Assoc J 2006, 8:832–835. 13. Wong MT, Eu KW: Primary colorectal lymphomas. Colorectal Dis 2006, 8:586–591. 14. Stein H, Lennert K, Feller AC, Mason DY: Immunohistological analysis of human lymphoma: correlation histological andimmunological categories. Adv Cancer Res 1984, 42:67–147. 15. Ohshima K, Kawasaki C, Muta H et al. CD10 and Bcl10 expression in diffuse large B-cell lymphoma: CD10 is a marker of improved prognosis. Histopathology 2001, 39(2):156–162. 16. Chou YH, Hsu HL, Lee JC, Lin BR, Liu KL: Emphysematous colitis of ascending colon with portal venous air caused by diffuse large Bcell lymphoma. J Clin Oncol 2010, 28(28):496–497. 17. Kashi MR, Belayev L, Parker A: Primary extranodal Hodgkin lymphoma of the colon masquerading as new diagnosis of Crohn’s disease. Clin Gastroenterol Hepatol 2010, 8:A20. 18. Shipp MA, Harrington DP, Anderson JR et al.: A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med 1993, 329:987–994. 19. Tondini C, Giardini R, Bozzetti F, Valagussa P, et al.; Combined modality treatment for primary strointestinal non- Hodgkin’s lymphoma: The Milan cancer Institute experience. Ann Oncol 1993;4: 831-7. 20. Quayle FJ, Lowney JK: Colorectal lymphoma. Clin Colon Rectal Surg 2006, 19(2):49–53. 21. Risio et al.: Diffuse large B-cell lymphoma of the colon with synchronous liver metastasis: a rare case report mimicking metastatic colorectal adenocarcinoma. BMC Surgery 2014 14:75.Abstract
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