Clinical Image
Co-Existing Primary Malignant Lymphoma and Adenocarcinoma of the Intestinal Tract
Ali Ezer and Alper Parlakgumus*
Department of General Surgery, BaskentUniversity School of Medicine, Adana, Turkey
*Corresponding author: Alper Parlakgumus, Department of General Surgery, Başkent Üniversitesi Araştırma ve Uygulama Hastanesi, Dadaloğlu mah. 39. Sk. No: 6, Yüreğir, Adana, Türkey
Published: 07 Aug, 2017
Cite this article as: Ezer A, Parlakgumus A. Co-Existing
Primary Malignant Lymphoma and
Adenocarcinoma of the Intestinal Tract.
Clin Surg. 2017; 2: 1585.
Keywords
Malignant lymphoma; Adenocarcinoma; Intestinal tract; Coexistance
Clinical Image
Synchronous occurrence of malignant lymphoma and carcinoma, both located in the intestinal
tract is unusual [1]. We present an unusual case of synchronous adenocarcinoma of the sigmoid
colon and T-cell lymphoma of the terminal ileum with involvement of the regional lymphnodes.
An 88-year-old woman was admitted to the hospital with anorexia and weight loss. Abdominal
CT revealed wall thickening surrounding the terminal ileum (Figure 1a). Also splenomegaly and
splenic multipl hypodens lesions and lymphadenopathies in thorax and abdomen were detected.
Colonoscopy revealed ulcerated mass in both terminal ileum and sigmoid colon (Figure 1b and c).
Adenocarcinoma in the sigmoid colon and diffuse large B cell lymphoma in the terminal ileum were
detected on permenant pathology report. In the exploration, there was a massive lesion occluding
the terminal ileal lumen adherent to the abdominal wall (Figure 1d). The patient underwent
sigmoid colon and ileocecal resection. Lymph node was detected in 24 lymph nodes in the ileocecal
resection material. 15 lymph nodes were negative in sigmoid colon resection (T3N0). The patient
was discharged without any problems on the post-operative 6th day. Chemotherapy for lymphoma
was initiated by medical oncolgist.
Approximately 2%-7% of colorectal carcinomas present with synchronous or metachronous
tumors [2]. Synchronous colonic carcinoma and lymphoma in the same patient is a rare occurrence.
Probability was estimated at 0.0002% [3]. Lee et al. [1] consider that old age and decreased immunity
may be the risk factors for coexisting primary malignant lymphoma
And colon adenocarcinoma in one patient. Cornes reported that coexisting adenocarcinomas
either ocur synchronously or follow, but never precede lymphoma [4]. In addition, the current lymphoma extended systemically and occupied the regional lymph
node, thus suggesting that lymphoma preceded the adenocarcinoma
and was predominant. Malignant lymphoma was clinically dominant
in the current case and the initial systemic chemotherapy was directed
against malignant lymphoma.
Figure 1
Figure 1
a: Abdominal CT revealing the wall thickening surrounding the terminal ileum (red arrow). b:
Colonoscopy revealing ulcerated mass in terminal ileum. c: Colonoscopy revealing ulcerated mass in sigmoid
colon. d: Massive lesion occluding the terminal ileal lumen adherent to the abdominal wall(red arrow).
References
- Lee DY, Hong SW, Chang YG, Lee WY, Lee B, Kang YK. Synchronous T-cell lymphoma in patient with colon cancer: a case report. J Korean Surg Soc. 2012;83(1):60-4.
- Ekelund GR, Pihl B. Mutiple carcinomas of the colon and rectum. Cancer. 1974;33(6):1630-4.
- Barron BA, Localio SA. A statistical note on the association of colorectal cancer and lymphoma. Am J Epidemiol. 1976;104(5):517-22.
- Cornes JS. Multiple primary cancers: primary malignant lymphomas and carcinomas of the intestinal tract in the same patient. J. Clin Pathol. 1960;13(6):483-9.