Jason J. John, BS1, Elizabeth S. John, MD2, Jeffrey Linder, MD2
1Virginia Commonwealth University School of Medicine, Richmond, VA; 2Methodist Dallas Medical Center, Dallas, TX
Introduction: Although extranodal lymphomas are most commonly found in the gastrointestinal (GI) tract, colorectal lymphomas are a rare diagnosis accounting for only 0.2% of large intestinal malignancies and 4% of malignancies in the entire GI tract. We report a case of a female patient with vague abdominal symptoms, ultimately diagnosed with diffuse large B-cell lymphoma (DLBCL) of the colon.
Case Description/Methods: A 55 year old African American female with HIV (CD4 164) was admitted for acute shortness of breath and 4 months of intermittent diffuse abdominal pain. She denied any diarrhea, changes in bowel habits, hematochezia, melena, or weight loss. Imaging revealed a pneumonia and nonspecific mesenteric lymphadenopathy (LAD), but no bowel abnormalities. Her abdominal pain initially improved with treatment of the pneumonia, but she was readmitted to the hospital one month later with recurrence of the abdominal pain and worsening shortness of breath. Vitals included BP 136/94, HR 125, RR 25, SpO2 90%, T 98.5. Exam showed bibasilar crackles and accessory muscle use with respirations. She had diffuse abdominal tenderness without obvious hepatosplenomegaly or LAD. Laboratory workup showed WBC 5.2 (normal differential), Hb 11.0, Platelets 361, normal CMP, BNP 300, LDH 9,845. CT revealed new bilateral pleural effusions, nonspecific mesenteric LAD, and mild transverse colon thickening (Figure 1). Colonoscopy revealed a non-obstructive 4 cm mass in the transverse colon. Biopsies revealed high-grade DLBCL. Thoracentesis confirmed the diagnosis. Before treatment could be initiated, the patient expired from tumor lysis syndrome and subsequent cardiac arrest.
Discussion: Colorectal lymphoma is extremely rare. Early recognition is crucial as stage I and II disease can be treated with surgery and chemotherapy, and if not treated, the mortality rate is 58%. Though DLBCL can occur in 5-10% of patients with HIV, the incidence of GI involvement in this population is still as low as 3%. As with our patient, diagnosis is often delayed due to nonspecific and non-localizing symptoms and signs. Imaging can be helpful, but can have a wide variety of characteristics–bulky masses, diffuse infiltration, multi-site involvement, and lymphadenopathy. Definitive diagnosis relies on histologic analysis. Later diagnosis also limits treatment. Management of stage I and II include chemotherapy and surgery while stage III and IV often require clinical trials. This case presentation highlights the importance of early diagnosis.
Citation: Jason J. John, BS; Elizabeth S. John, MD; Jeffrey Linder, MD. P1060 - COLORECTAL LYMPHOMA: A WOLF IN SHEEP'S CLOTHING. Program No. P1060. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.