Diffuse large B-cell lymphoma originating from the rectum and diagnosed after rectal perforation during the treatment of ulcerative colitis: a case report

• Published in: BMC surgery 2021-01, Vol.21 (1), p.50-5, Article 50
• Main Authors: Suzuki, Takafumi, Iwamoto, Kazutsugu, Nozaki, Ryoichi, Saiki, Yasumitsu, Tanaka, Masafumi, Fukunaga, Mitsuko, Yamada, Kazutaka
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Anastomosis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; B-cell lymphoma; Biopsy; Cancer; Case Report; Chemotherapy; Colectomy; Colitis, Ulcerative - complications; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Complications; Complications and side effects; Computed tomography; Corticosteroids; CT imaging; Cyclophosphamide; Cyclophosphamide - therapeutic use; Cytomegalovirus; Cytomegalovirus infections; Diagnosis; Diffuse large B-cell lymphoma; Doxorubicin; Doxorubicin - therapeutic use; Drug therapy; Endoscopy; Health services; Humans; Ileostomy; Immunosuppressive agents; Inflammatory bowel disease; Intestinal perforation; Intestinal Perforation - etiology; Intestinal Perforation - surgery; Intestine; Lymphocytes; Lymphocytes B; Lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - etiology; Lymphoma, Large B-Cell, Diffuse - surgery; Male; Malignancy; Medical research; Medicine, Experimental; Mesalamine; Metastases; Monoclonal antibodies; Non-Hodgkin's lymphomas; Pain; Patients; PET imaging; Positron emission; Positron emission tomography; Prednisolone; Prednisone - therapeutic use; Prognosis; Rectal Neoplasms - diagnosis; Rectal Neoplasms - drug therapy; Rectal Neoplasms - etiology; Rectal Neoplasms - surgery; Rectum; Rectum - injuries; Rectum - pathology; Rectum - surgery; Risk analysis; Risk factors; Rituximab; Rituximab - therapeutic use; Surgery; Targeted cancer therapy; TNF inhibitors; Tumor necrosis factor-TNF; Ulcerative colitis; Ulcers; Vincristine; Vincristine - therapeutic use
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-021-01060-2

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. A 43-year-old man with severe lower abdominal pain and an 8-year history of UC was admitted in our hospital. He was diagnosed UC since 8 years and received a maintenance oral dose of 5-aminosalicylic acid, and no other immunosuppressive drugs. A deep rectal ulcer was endoscopically diagnosed 10 months before admission, no malignancy or cytomegalovirus infection was detected on biopsy. After 7 months a further endoscopy with biopsies confirmed the finding and the absence of malignancy. Three months later the patient developed sudden abdominal pain and was admitted in our hospital. Rectal perforation was suspected on X-ray and computed tomography imaging, and an emergency surgery was performed. Surgical exploration revealed a perforation on the anterior wall of the rectum. A subtotal colectomy with temporary ileostomy was performed. Pathology examinations showed lymphocyte infiltration of all of the layers of the perforated site and an immunohistochemical evaluation revealed DLBCL. Clinical staging was stage IV, and the patient received a 6-months regimen of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Positron emission tomography restaging revealed disappearance of distant uptake and a slight uptake in the residual rectum, and completion proctectomy with ileal pouch-anal anastomosis was performed. No residual tumor in the specimen was found, and the patient was disease-free at 2 years follow-up. DLBCL may increase the frequency of perforation and is a poor prognostic risk factor for patients with UC. This case study emphasizes the importance of careful medical surveillance and repeated endoscopic biopsies during the treatment of UC.