Ewha Med J.  2016 Apr;39(2):51-55. 10.12771/emj.2016.39.2.51.

Diffuse Large B-Cell Lymphoma Transformed from a Rectal Mucosa-Associated Lymphoid Tissue Lymphoma

• Kang SH
• Park JW
• Jung BW
• Song JG
• Oh HS
• Park K

• KMID: 2171365
• DOI: http://doi.org/10.12771/emj.2016.39.2.51

Abstract

Primary rectal lymphoma is a rare disease among the gastrointestinal (GI) lymphoma. In particular, diffuse large B-cell lymphoma (DLBCL) transformed from mucosa-associated lymphoid tissue (MALT) lymphoma is often the primary type of GI lymphoma, mostly in stomach or duodenum, but has never been reported in rectum. Here we report an unusual case in which a 75-year-old male patient diagnosed with DLBCL transformed from MALT lymphoma in the rectum. The patient was diagnosed as rectal DLBCL transformed from MALT lymphoma as Lugano stage II2 and was treated with chemotherapy (R-CHOP) with CD-20 monoclonal antibody (rituxaimb). Complete remission of multiple lymphadenopathy and mass forming ulcer of the rectum was achieved after 6 cycles of R-CHOP. He has been free from disease for 12 months.

Keyword

MALT lymphoma; Diffuse large B-cell lymphoma; Rectum

MeSH Terms

Aged
B-Lymphocytes*
Drug Therapy
Duodenum
Humans
Lymphatic Diseases
Lymphoid Tissue
Lymphoma
Lymphoma, B-Cell*
Lymphoma, B-Cell, Marginal Zone*
Male
Rare Diseases
Rectum
Stomach
Ulcer

Figure

• 

  Fig. 1 Colonoscopic findings. (A) About 10 mm sized mass-forming lesion with nodularity is observed on rectum. It is diagnosed as mucosa-associated lymphoid tissue lymphoma. (B) About 20 mm sized mass-forming ulcer is observed on rectum, Anal verge (AV) 5 cm. This lesion has vulnerability that doesn't have definite demarcation with surrounding normal mucosa. It is diagnosed as diffuse large B-cell lymphoma.

• 

  Fig. 2 Histopathologic findins of mucosa-associated lymphoid tissue lymphoma (A) and diffuse large B-cell lymphoma (B-D). H&E stain (×200) on rectal biopsy of 20 mm sized mass-forming ulcer shows monomorphic lymphocytic infiltrating of the lamina propria surrounds colonic glands massively infiltrated with atypical lymphocytes and undergoing destruction (lymhpoepithelial lesion) (A). Rectal biopsy specimens of 20 mm sized mass-forming ulcer lesion with nodularity show strong immunoreactivity for BCL 2 stain (×200) (B) and CD 20 stain (×200) (C). (D) H&E stain (×200) shows tumor cells with round or oval nuclei, open chromatin, and prominent nucleoli.

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  Fig. 3 Abdomen and pelvis computed tomography findings at initial presentation. They show circumferential anorectal thickened tissue associated with retro-rectal lymphadenopathy (A) and paraaortic multiple lymphadenpathy (B).

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  Fig. 4 Fluorine-18-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (18F-FDG PET CT) findings. They show increased FDG uptake in rectal and retroperitoneal paraaortic lymph nodes, which suggest the involvement of lymphoma (A, B).

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