Maimonides Medical Center Great Neck, NY, United States
Kaveh Zivari, MD, Fahad Zafar, MBBS, Shmuel Golfeyz, MD, Daria Yunina, MD, Meredith E. Pittman, MD, Kadirawelp Iswara, MD Maimonides Medical Center, Brooklyn, NY
Introduction: The gastrointestinal (GI) tract is the predominant site of extra-nodal non-Hodgkin lymphomas (NHL). While secondary involvement of GI tract is relatively common, the primary NHL of GI tract is rare. Cases, where a patient is found to have 3 different cancers, are extremely rare. Here we report a case of a patient with colonic adenocarcinoma, primary colonic diffuse large B-cell lymphoma (DLBCL), and myelodysplastic syndrome (MDS)
Case Description/Methods: A 92-year-old female with history of lung cancer that was resected, gastric lymphoma treated with rituximab, breast cancer, and a new diagnosis of MDS on IV iron is seen in the emergency room for epigastric abdominal pain, fever, nausea, and unintentional weight loss. Her CT of abdomen/pelvis showed lobulated 4.3 cm peripherally enhancing fluid collection in the left upper quadrant adherent to the splenic flexure of the colon and infiltrating the inferior pole of the spleen with possible fistulous communication between the collection and the colon. The patient was found to be bacteremic with vancomycin-resistant enterococci. Colonoscopy was performed wherein descending colon large inflammatory, erythematous polypoid appearing friable mass with a large ulcerated area representing possibly the mouth of the fistulous tract was seen. Further in the cecum a 2.5cm Paris classification Ip, Kudo pit pattern V, polyp was seen and was resected. Pathology showed cecal polyp to be adenocarcinoma, and the large ulcerated area to be DLBCL. Due to the presence of splenic abscess patient was taken for subtotal colectomy and splenectomy. The patient was later discharged for further treatment by oncology. The patient was doing well 10 months out from this event.
Discussion: Finding and treatment of multiple cancers in the same patient can be very challenging and requires multiple specialties to work together. Although cecal adenocarcinoma and descending colon DLBCL were diagnosed at the same time it is not clear if their origin is related. In our patient, MDS could be a side effect of the patient's previous chemotherapy regimen for her breast and lung cancer vs gastric lymphoma treatment. Although it is thought that patients with multiple coexisting cancers have a poor prognosis with the survival of only several months, our patient was seen 10 months after this event back in hospital for a problem not related to her malignancies.