Synchronous colonic B cell lymphoma and adenocarcinoma in an elderly patient treated with R-mini-CHOP followed by resection

Abstract

The simultaneous diagnosis of colonic lymphoma and adenocarcinoma in the same location is rare and presents challenges in its treatment considerations, especially in elderly patients. While previous cases have been described, there is little consistency in treatment regimens, and outcomes are generally poor. We describe the case of a man in his late 80s who presented with primary cecal and colonic B cell lymphoma, treated with R-mini-CHOP chemotherapy, but was found to have a residual adenocarcinoma in the cecum after treatment that was then successfully resected. The patient remains alive and well 3 years postoperation. This case highlights the need to consider lymphoma as a possible diagnosis for any colonic mass, and the need to consider rebiopsy of residual abnormal-appearing tissue postchemotherapy to confirm the diagnosis. Moreover, our report affirms that aggressive, curative-intent treatment with age-adjusted chemotherapy, and subsequent surgical resection is feasible for certain elderly patients with dual malignant diagnoses.

Keywords: Chemotherapy; Colon cancer; Malignant and Benign haematology; Oncology.

Figure 1

Diagnostic CT imaging. Coronal sections of baseline diagnostic CT abdomen and pelvis (A) and CT chest (B) showing a thickened cecum (red arrow) and diffuse adenopathy (yellow arrows).

Figure 2

Histopathology. H&E stained pathology slides from initial biopsy shows atypical lymphocytes percolating through the lamina propria of an adenoma with villous features (A). One biopsy sample shows atypical lymphocytes on left and fragment of high-grade dysplastic villous adenoma on the right (B). At higher magnification, a focus of these abnormal lymphocytes (C) and villous adenoma with high-grade dysplasia (D) are visible. Posthaemicolectomy pathology shows invasive colonic adenocarcinoma at low magnification (E) and high magnification (F).

Figure 3

Postchemotherapy PET-CT imaging. Axial sections of CT before chemotherapy treatment (A) and PET-CT after six cycles of R-mini-CHOP chemotherapy (B). Residual tumour showing high FDG uptake is at the same location at the primary tumour site within the cecum (red arrows).