Introduction: Extranodal lymphomas are found to commonly involve the gastrointestinal tract but cecal involvement is a rare manifestation of the disease state. Diffuse large B cell lymphoma is an aggressive type of Non-Hodgkins lymphoma that can arise at different stages of mature B cell differentiation due to mutations in the BCL-2 and BCL-6 genes.
Case Description/Methods: This is a case of a 78 year old man with a history of hypertension and a previous Burkett's lymphoma in the third part of the duodenum which was successfully treated with chemotherapy 8 years prior. He presented with lower abdominal pain and constipation. A CT indicated a large cecal mass without evidence of metastasis. A subsequent colonoscopy revealed a large ulcerated cecal mass with the biopsies confirming a diffuse large B-cell lymphoma positive for CD10, CD43, BCL-6 and MUM-1. The biopsies were negative for CD5 and Cyclin-D1. He opted for treatment with chemotherapy instead of surgical resection. Oncology service initiated one cycle of Rituximab, Ifosfamide, Carboplatin and Etoposide and he was then switched to Monjuvi and Lenalidomide with excellent clinical response. Repeat CT/PET as well as a colonoscopy showed complete resolution of the mass and he has remained asymptomatic 12 months after completion of treatment without evidence of recurrent disease.
Discussion: Colonic involvement of lymphoma is rare and the gastrointestinal symptoms on presentation can be similar to other colonic malignancies, but the treatment rational is usually different involving chemotherapy as opposed to surgery as first line treatment. This case highlights the successful treatment of a patient who has shown continued remission after treatment of his cecal lymphoma and has now survived two different lymphomas of the gastrointestinal tract.
.jpg "Diana Lei S. Dy, RN, BSN photo")