Primary diffuse large B-cell lymphoma developing within a rectal tubular adenoma with low-grade dysplasia: a case report

Abstract

Introduction: Colorectal lymphomas represent only 5% to 10% of gastrointestinal lymphomas, after the stomach and small intestine. Primary lymphoma of the colon and rectum is an unusual observation, constituting only 0.2% to 0.5% of all malignant tumors arising from the colorectal region. Very little is known about the correlation between adenoma and lymphoma in the colorectal tract. We report here a rare case of diffuse large B-cell lymphoma developing within a solitary tubular adenoma with low-grade dysplasia of the rectum.

Case presentation: An 83-year-old Caucasian man was referred to our hospital intermittent anal bleeding and irregular bowel. Colonoscopy revealed a 1cm solitary rectal polyp, which was completely removed by endoscopic resection. Histologic studies revealed low-grade intraepithelial dysplasia; the stroma of adenoma showed focal localization by highly proliferative lymphoid cells. Immunohistochemical analyses demonstrated that lymphoid cells were positive for CD20 and bcl2, whereas they were negative for CD3, CD5, CD10, CD23, CD30, CD138 and cyclin D1. Approximately 90% of the neoplastic cells reacted positively when stained with an antibody to Ki-67. Molecular studies showed the presence of a monoclonal immunoglobulin heavy chain gene rearrangement.To determine primary or secondary lymphoma localization, Dawson's criteria were applied to the case. A diagnosis of primary diffuse large B- lymphoma Ann Arbor stage 1A was established. Subsequently, the patient was referred to oncology to establish the stage and to select appropriate treatment.

Conclusions: The case of diffuse large B-cell lymphoma developing within a tubular adenoma, as reported here, is considered a rare event. Little about the prognosis of primary colorectal lymphomas is available and therapeutic treatment protocol is unclear. This case report provides more information on the history and macroscopic appearance of lymphomas presenting in an unusual location. To report additional cases in the future would be helpful in redefining the diagnostic, prognostic and therapeutic approach.

Figure 1

Polyp.

Figure 2

Histological and immunohistochemical stains. (a) Polyp histological section, original magnification × 13; (b) tubular adenoma with low-grade intraepithelial dysplasia and focal localization in the stroma by highly proliferative large lymphoid cells, hematoxylin and eosin, original magnification × 160; (c) and × 400; (d) CD20×12; (e) and × 100; (f) Ki-67×100.

Figure 3

Agarose gel electrophoresis to detect the rearrangement of the immunoglobulin heavy chain semi-nested polymerase chain reaction products. Lane MK (marker): Deoxyribonucleic acid (DNA) ladder (100-bp to 1000-bp fragments); lane 1: negative control (no DNA); lane 2: patient sample; lane 3 monoclonal control; lane 4: polyclonal control. A positive β-globin amplification was performed (lane not shown).