Non
Hodgkin Lymphoma of Large Bowel- a case report
Dr .Sunil. S. Byadgi MS, Dr.
P. Nagaraj MS, Dr. Shashikala P MD
S.S.Institute of Medical
Science and Research Center
Davangere. Karnataka –
577005, India
Introduction
Gastro Intestinal
lymphomas are the most common extra nodal Non Hodgkin lymphoma. Most
Gastro Intestinal lymphoma are low Grads B cell lymphoma and originate
from the Mucosa associated lymphoid tissue. The condition is rare in
females and young patients.
Case Report
The patient, A 26 year
old Male had noticed a mass of 4*4 cms in the lower abdomen for two months
which had rapidly grown to a present size of 8*8 cms. Patient had a
history of severe backache with no Neurological deficits. Patient himself
was moving the swelling from pelvis in to the right lateral abdomen. No
other bowel related symptoms and no previous Surgeries done.
Patient had mild pallor
and large mass in right iliac fossa, freely mobile, which could be dropped
into the pelvic inlet. The skin over the abdomen was normal.All quadrants
moved equally with respiration. Per rectal examination was normal, routine
investigations were normal. Stool for occult blood negative.
Colonoscopy revealed a
submucosal lesion around caecum with no ulceration in the lumen.
CEA was negative.
C.T. scan of abdomen pelvis
showed a well defined minimally enhancing heterogenous mass lesion of
10x9x8cm with indentation of bladder fundus and areas of necrosis seen
with in the mass. It was reported as mesenteric lymph node mass with
indentation on bladder and bowel. X-ray, CT guided FNAC was done with no
definite opinion. pre- operative cystoscopy was found to be normal An
exploratory laparotomy was planned.
A right lower paramedian
incision was undertaken under epidural anesthesia. A large pediculated
mass of 8x9cm was arising ftrom the medial wall of caecum .Few lymph nodes
in the mesentery were found. Mass was freely mobile and the patient had a
deep pelvis where the mass could easily rest within. Mild ascitis present,
no iliac group of lymph nodes, no Para aortic lymphadenopathy, no lesion
in liver. Right hemicolectomy was done
Discussion
Although extranodal
presentations of non-Hodgkin’s lymphomas are rare, the gastrointestinal
tract is the most common site of extranodal involvement. The majority of
colorectal lymphomas is non-Hodgkin’s type and may present with low-,
intermediate, or high-grade histologies. B-cell diffuse large cell
histologic type is most common: however, virtually all B-cell and T-cell
types may occur. Approximately 13% to 18% of gastrointestinal tract
lymphomas arise in the large bowel the majority are situated in the cecum
or the rectum.
Colorectal lymphomas usually
present with nonspecific abdominal pain, weight loss, rectal bleeding,
mass, or obstruction. The clinical presentation is similar to that of
common colorectal carcinoma, and the diagnosis is made on histological
examination of a biopsy specimen. Extensive workup for other sites of
disease, including bone marrow biopsy and full body scanning, is necessary
both for staging and for acceptance of the diagnosis of the
gastrointestinal site as primary.
Owing to the rarity of the
disease, data regarding the optimal management of large bowel lymphomas
are scarce. Patients with lymphoma of the colon are often treated
initially with surgery, although the appropriateness of this practice has
not been validated in randomized studies. A combined modality approach,
including surgery and chemotherapy, has been advocated by some
investigators. The role of radiation therapy also remains unclear, with
some investigators favoring its use, especially for treatment of
unresectable disease or bulky tumors. Chemotherapy use is based on the
appropriate regimens for the particular histologic subtype that is
present.
