Investig Magn Reson Imaging.  2019 Dec;23(4):374-380. 10.13104/imri.2019.23.4.374.

Collison Tumor of Adenocarcinoma and Diffuse Large B-Cell Lymphoma in the Rectum: a Case Report and Literature Review

• Kim SH

• KMID: 2468055
• DOI: http://doi.org/10.13104/imri.2019.23.4.374

Abstract

Collision tumor is a synchronous neoplasm wherein two histologically distinct tumors co-exist within the same anastomosis site. Collision tumor can occur in any organ, but the incidence is markedly rare. Additionally, preoperative diagnosis can be challenging to the radiologist. Herein, we report an age 60 male with collision tumor of rectal adenocarcinoma and diffuse large B-cell lymphoma, presented as a semi-annular wall thickening and bulky exophytic mass on MR imaging.

Keyword

Collision tumor; Rectum; Adenocarcinoma; Lymphoma; MR imaging

MeSH Terms

Adenocarcinoma*
B-Lymphocytes*
Diagnosis
Humans
Incidence
Lymphoma
Lymphoma, B-Cell*
Magnetic Resonance Imaging
Male
Neoplasms, Multiple Primary
Rectum*

Figure

• 

  Fig. 1 An age 62 male with collision tumor of rectal adenocarcinoma and DLBCL. (a) Axial CT image obtained from portal venous phase shows a lobulated, relatively homogeneous enhancing mass (arrows) in the left mesorectum. The mass is compressing the distal rectum. (b) On a T2-weighted MR image, the mesorectal mass (asterisk) shows homogeneous, intermediate signal intensity. Additionally, there is a semi-annular wall thickening (arrow) in the left quadrant of the compressed distal rectum, which shows lower signal intensity than that of the mesorectal mass. (c) On a T2-weighted MR image, two nodular lesions, similar to the signal intensity of the mesorectal mass, are noted in the seminal vesicle (arrow) and the left femoral head (arrowheads). (d) On diffusion-weighted image, there is a linear area of non-restricted diffusion (arrows) between the semi-annular wall thickening (obelisk) and the mesorectal mass (asterisk). (e) On colonoscopy, the semi-annular wall thickening on MR image appears as an ulceroinfiltrative lesion with easy contact bleeding. (f) A photograph of colonoscopic biopsy specimen (Hematoxylin and Eosin [H&E] stanning) shows moderately differentiated adenocarcinoma with glandular formation (arrow). (g) H&E stanning from percutaneous needle biopsy specimen demonstrates an abnormal diffuse infiltrate of small to intermediate-sized lymphoid cells. (h) CD20 B-cell marker are positive.

• 

  Fig. 2 MR images after six-cycle CHOP chemotherapy. (a, b) On a T2-weighted image, a semi-annular wall thickening (arrows) in the left quadrant of the distal rectum is noted. Previously seen mesorectal mass disappeared and remained as a thin low signal intensity lesion (asterisk), indicating a complete response.

Reference

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