Figure - available from: BMC Surgery
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Resected rectosigmoid colon specimen. The perforation site is visible on the resected rectosigmoid colon. The mucosa is mostly normal except for the perforation site
Source publication
Background
Gastrointestinal lymphomas like diffuse large B-cell lymphoma (DLBCL) are rare complications of ulcerative colitis (UC), and only a few studies have reported intestinal ulcers caused by DLBCL, which got perforated during the treatment of UC.
Case presentation
A 43-year-old man with severe lower abdominal pain and an 8-year history of UC...
Citations
... Instead of a distinct inclination for spontaneous free perforation development at a specific site in CD, possibly linked to the thinner wall of the ileum when compared with the jejunum, The perforation rate in gastrointestinal lymphoma is about 9%-22%, exceeding the rate observed in high-grade lymphomas such as DLBCL [7]. DLBCL represents a fast-growing B-cell lymphoma, histologically identified by the widespread growth of large cancerous B lymphoid cells whose nucleus size matches or surpasses the nuclei of typical histiocytes [8]. ...
... Primary gastrointestinal lymphoma can lead to a reduction in the mechanical integrity of the gastrointestinal wall, potentially resulting in intestinal perforation [7]. Several studies have indicated that perforation is an unfavorable prognostic indicator for individuals with high-grade lymphomas such as DLBCL [3]. ...
Adenocarcinoma and lymphoma, potential complications of Crohn's disease (CD), may result in small intestinal perforations, particularly in those on immunosuppressive therapy. The ileum is typically the site of small intestinal perforations in CD, and the link between CD and lymphoma remains uncertain. This case report explores a long-term CD patient on immunosuppressive therapy who presented with acute abdominal pain. Imaging revealed signs of intestinal perforation, successfully managed with surgery. The final pathology report confirms the diagnosis of diffuse large B-cell lymphoma. This report sheds light on the complicated nature of gastrointestinal lymphoma in CD patients.
... In the present case, however, primary rectal DLBCL developed in the absence of previous or current immunomodulatory therapy for the treatment of UC. Although being extremely rare, similar cases have been reported in the literature [10,12,13], raising the hypothesis of alternative mechanisms contributing to the development of DLBCL in UC patients [10]. One of the possible mechanisms is overstimulation of the immune system secondary to chronic colorectal inflammation. ...
Introduction:
The incidence of primary colorectal lymphoma in the gastrointestinal tract is very low, the rectum being infrequently affected. The development of this entity in inflammatory bowel disease patients usually occurs in a context of immunosuppression-based therapy, with only a few case reports describing its development in patients presenting no known risk factors. Moreover, the clinical presentation of primary colorectal lymphomas may be difficult to distinguish from an acute flare of ulcerative colitis (UC).
Case Presentation:
We present a case of non-Hodgkin lymphoma of the rectum in a 42-year-old male with a 7-year history of UC and no previous exposure to immunomodulatory agents. He presented with a history of mucous diarrhoea, tenesmus, proctalgia and weight loss, refractory to optimized therapy. A lower gastrointestinal endoscopy was performed revealing a circumferential ulcerated lesion of the rectum, from which histopathological analysis established the diagnosis of a non-Hodgkin diffuse large B-cell lymphoma (DLBCL).
Discussion/Conclusion:
The present case suggests the existence of alternative mechanisms for the development of DLBCL in UC patients. The clinical presentation mimicking an acute flare of UC posed a diagnostic challenge, highlighting the complexity behind the management of UC patients.
