Year: 2024
Type: article
Study design: Case Report
Abstract: Case Presentation Patient FJS, 62 years old, male, with a sole complaint of intestinal bleeding. Colonoscopy revealed oval erosions covered by fibrin at the ileocecal valve, without histological characteristics of inflammatory bowel disease (IBD). A biopsy showed lymphoid infiltration in the cecum, inconclusive for small B-cell lymphoma. Immunohistochemistry confirmed the diagnosis, with Ann Arbor staging IA (modified). Tests for sexually transmitted infections (STI) were negative. CT scans of the abdomen/chest and PET CT were negative. Endoscopy showed no apparent lesions and was negative for *H. Pylori*. The patient underwent right hemicolectomy, with pathology confirming a diffuse B-cell lymphoid neoplasm (M.A.L.T lymphoma) in the mucosa and submucosa of the cecum/ileocecal valve, measuring 2.5 cm at its largest extent. Discussion Primary extranodal lymphoma is defined as involvement of a primary organ without clinical evidence of distant lymph node or organ spread. Colon marginal zone lymphomas are extremely rare, accounting for 2-3% of all colonic neoplasms. The cecum is the most commonly affected site, followed by the rectum. There is a male predilection. On average, colorectal lymphoma is diagnosed in individuals aged 50 to 60 years. The pathology in the colon arises from chronic antigenic stimulation secondary to infectious agents or autoimmune processes occurring in the mucosa. Risk factors for primary extranodal non-Hodgkin lymphoma (NHL) include a family history of lymphoma, personal history of radiation or chemotherapy, organ transplantation, immunosuppression, viral immunity, and exposure to toxins. Immunosuppressive medications for IBD have been associated with an increased risk of gastrointestinal lymphoma. Diagnosis is made through biopsy analysis, obtained either by colonoscopy or histology of the surgical resection specimen. Treatment modalities include radiotherapy, which can be used alone, or Rituximab as monotherapy, or Rituximab with chemotherapy in advanced disease. Surgical treatment is also an individualized option for stages I and II. Conclusion Primary colon lymphoma is an indolent disease, with recurrence in nearly all cases. The choice of surgical treatment is individualized, typically recommended in the early stages of the disease, and the decision should involve hematologists and surgeons. In this case, the patient benefits from not undergoing alternative therapies such as radiotherapy, Rituximab, or chemotherapy, which may be considered in cases of disease recurrence. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
Source: Journal of Coloproctology
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4409791919