Primary diffuse large B-cell lymphoma developing within a rectal tubular adenoma with low-grade dysplasia: a case report

Journal of Medical Case Reports

Vincenzo Tralongo¹  Elisa Varriale²  Giuseppa Scaglione¹  Benedetto Giacalone¹  Gabriella Ottoveggio¹  Claudia Nagar¹  Gaspare Becchina¹  Francesco Genovese¹ 

[1] Department of Diagnostic Laboratory, U.O.C. of Pathological Anatomy, “G.F. Ingrassia” Hospital, ASP Palermo, Italy;Oncology Unit, “Buon Consiglio Fatebenefratelli” Hospital, Naples, Italy

关键词: Polyp;    Gastrointestinal lymphoma;    Diffuse large B-cell lymphoma;    Adenoma;   

Others  :  822462
DOI  :  10.1186/1752-1947-8-103

 received in 2013-08-09, accepted in 2014-01-22,  发布年份 2014

【 摘 要 】

Introduction

Colorectal lymphomas represent only 5% to 10% of gastrointestinal lymphomas, after the stomach and small intestine. Primary lymphoma of the colon and rectum is an unusual observation, constituting only 0.2% to 0.5% of all malignant tumors arising from the colorectal region. Very little is known about the correlation between adenoma and lymphoma in the colorectal tract. We report here a rare case of diffuse large B-cell lymphoma developing within a solitary tubular adenoma with low-grade dysplasia of the rectum.

Case presentation

An 83-year-old Caucasian man was referred to our hospital intermittent anal bleeding and irregular bowel. Colonoscopy revealed a 1cm solitary rectal polyp, which was completely removed by endoscopic resection. Histologic studies revealed low-grade intraepithelial dysplasia; the stroma of adenoma showed focal localization by highly proliferative lymphoid cells. Immunohistochemical analyses demonstrated that lymphoid cells were positive for CD20 and bcl2, whereas they were negative for CD3, CD5, CD10, CD23, CD30, CD138 and cyclin D1. Approximately 90% of the neoplastic cells reacted positively when stained with an antibody to Ki-67. Molecular studies showed the presence of a monoclonal immunoglobulin heavy chain gene rearrangement.

To determine primary or secondary lymphoma localization, Dawson’s criteria were applied to the case. A diagnosis of primary diffuse large B- lymphoma Ann Arbor stage 1A was established. Subsequently, the patient was referred to oncology to establish the stage and to select appropriate treatment.

Conclusions

The case of diffuse large B-cell lymphoma developing within a tubular adenoma, as reported here, is considered a rare event. Little about the prognosis of primary colorectal lymphomas is available and therapeutic treatment protocol is unclear. This case report provides more information on the history and macroscopic appearance of lymphomas presenting in an unusual location. To report additional cases in the future would be helpful in redefining the diagnostic, prognostic and therapeutic approach.

【 授权许可】

   
2014 Genovese et al.; licensee BioMed Central Ltd.

【 图 表 】

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