Korean J Gastroenterol.  2017 Feb;69(2):139-142. 10.4166/kjg.2017.69.2.139.

Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy

• Pyeon SI
• Song GA
• Baek DH
• Kim GH
• Lee BE
• Lee SJ
• Yoon JB
• Han SY
• Park DY

• KMID: 2383424
• DOI: http://doi.org/10.4166/kjg.2017.69.2.139

Abstract

The gastrointestinal tract is the most common site of extra-nodal non-Hodgkin lymphoma. However, the incidence of primary rectal lymphoma is extremely rare. Among the primary gastrointestinal lymphomas, follicular lymphoma has been described as a rare disease. It is difficult to diagnose rectal lymphoma due to its variable growth patterns and inadequate biopsies. Majority of patients with rectal lymphoma have non-specific symptoms or negative biopsies, often delaying the diagnosis. Our patient is a 62-year-old female. Two sessile and smooth subepithelial lesions with a yellowish normal mucosa were found on a screening colonoscopy. The initial mucosal biopsy finding was chronic inflammation, but we were highly suspicion of malignancy; we performed an endoscopic mucosal resection. Herein, we present a rare case of rectal follicular lymphoma diagnosed by endoscopic mucosal resection with a literature review.

Keyword

Follicular lymphoma; Rectum; Subepithelial tumor

MeSH Terms

Biopsy
Colonoscopy*
Diagnosis
Female
Gastrointestinal Tract
Humans
Incidence
Inflammation
Lymphoma
Lymphoma, Follicular*
Lymphoma, Non-Hodgkin
Mass Screening*
Middle Aged
Mucous Membrane
Rare Diseases
Rectum*

Figure

• 

  Fig. 1. Colonoscopic findings. (A) 4 mm subepithelial lesion on 3cm from anal verge, 3 mm subepitheliallesion on 2 cm from anal verge. (B) Smooth subepithelial lesion with yellowish colored normal mucosa on 3 cm from anal verge.

• 

  Fig. 2. EUS findings. 0.4×0.3 cm homogenous hypoechoic mass invaded second to third layer.

• 

  Fig. 3. Histologic findings. (A) Tumor is located in submucosa and invades into mucosa. The neoplastic follicles are poorly defined and show diffuse effacement (H&E, ×40). (B) Tumor cells are composed of centrocytes and centroblasts (H&E, ×400).

• 

  Fig. 4. Histologic findings. (A) Immunohistochemical staining for CD20. Tumor cells are positive for CD20 (×200). (B) Immunohistochemical staining for CD21 shows expanding follicular dendritic cell meshworks (×200).

Reference

References

1. Rudders RA, Ross ME, DeLellis RA. Primary extranodal lymphoma: response to treatment and factors influencing prognosis. Cancer. 1978; 42:406–416.

2. Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non-Hodgkin's lymphoma: II. Combined surgical and conservative or conservative management only in localized gastric lymphoma–results of the prospective German Multicenter Study GIT NHL 01/92. J Clin Oncol. 2001; 19:3874–3883.

3. Fan CW, Changchien CR, Wang JY, et al. Primary colorectal lymphoma. Dis Colon Rectum. 2000; 43:1277–1282.

4. Yoshino T, Miyake K, Ichimura K, et al. Increased incidence of follicular lymphoma in the duodenum. Am J Surg Pathol. 2000; 24:688–693.

5. 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.

6. Koniaris LG, Drugas G, Katzman PJ, Salloum R. Management of gastrointestinal lymphoma. J Am Coll Surg. 2003; 197:127–141.

7. Shia J, Teruya-Feldstein J, Pan D, et al. Primary follicular lymphoma of the gastrointestinal tract: a clinical and pathologic study of 26 cases. Am J Surg Pathol. 2002; 26:216–224.

8. Kwon BS, Kim CD, Park JY, et al. A case of primary follicular lymphoma arising in the rectum. Korean J Gastrointest Endosc. 2006; 33:285–288.

9. Damaj G, Verkarre V, Delmer A, et al. Primary follicular lymphoma of the gastrointestinal tract: a study of 25 cases and a literature review. Ann Oncol. 2003; 14:623–629.

10. Iwamuro M, Okada H, Takata K, et al. Colorectal Manifestation of Follicular Lymphoma. Intern Med. 2016; 55:1–8.

11. West RB, Warnke RA, Natkunam Y. The usefulness of immunohistochemistry in the diagnosis of follicular lymphoma in bone marrow biopsy specimens. Am J Clin Pathol. 2002; 117:636–643.

12. Hoh CK, Glaspy J, Rosen P, et al. Whole-body FDG-PET imaging for staging of Hodgkin's disease and lymphoma. J Nucl Med. 1997; 38:343–348.

13. Lapela M, Leskinen S, Minn HR, et al. Increased glucose metabolism in untreated non-Hodgkin's lymphoma: a study with positron emission tomography and fluorine-18-fluorodeoxyglucose. Blood. 1995; 86:3522–3527.

14. Kahl BS, Yang DT. Follicular lymphoma: evolving therapeutic strategies. Blood. 2016; 127:2055–2063.