Synchronous adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the colon

Abstract

Mucosa-associated lymphoid tissue (MALT) tumors are a distinct subtype of non-Hodgkin's lymphoma. Synchronous appearance of adenocarcinoma and colonic MALT lymphoma in the same patient is quite rare. In the present report, we describe a 68-year-old female who presented with a history of bleeding per rectum. She had no history of fever, loss of weight or drenching night sweats. Rectal examination revealed no abnormality. Colonoscopy showed a large ulceroproliferative mass arising from the hepatic flexure, biopsy of which came out to be adenocarcinoma of colon. A right hemicolectomy was performed and microscopic study revealed the tumor type to be synchronous adenocarcinoma with lymphoma. The final diagnosis of this patient turned out to be a synchronous manifestation of both colonic adenocarcinoma and colonic MALT lymphoma. Although the patient remains asymptomatic two years after surgery, the case highlights the therapeutic dilemma that prevails in the definitive management in such scenarios.

Figure 1

Malignant looking tumor cells arranged in clusters and acinar pattern, containing mucin suggestive of adenocarcinoma

Figure 2

Malignant looking lymphoid cells closely adherent and dispersed along a blood vessel suggesting angiocentricity as seen in high grade lymphomas. Also seen are cells arranged in clusters or acinar pattern suggestive of adenocarcinoma

Figure 3

Infiltration of malignant looking lymphoid cells in the lamina propria suggestive of malt lymphoma

Figure 4

Small to medium sized lymphoid cells having scant to moderate pale eosinophilic cytoplasm. Nucleus is grooved or cleaved with prominent nucleoli, vesicular chromatin. Cells are dispersed along the blood vessel showing angiocentricity and compressing the blood vessel into a slit like appearance