Colon Lymphoma colonic
Colonic lymphoma complicating pseudomembranous colitis.

Video Endoscopic Sequence 1 of 6.

Colonic lymphoma complicating pseudomembranous colitis.

Extensive lesion with Pseudomembranes, underneath there
are extensive ulceration and granular lesions.

Download the video clips by clicking on the endoscopic
images, if you wish to observe in full screen, wait to be
downloaded complete then press Alt and Enter for
Windows media, Real Player Ctrl and 3. 
Configure the windows media in repeat is optimal.
All endoscopic images shown in this Atlas contain
video clips. We recommend seeing the video clips in full
screen mode. 

 

Colonic lymphoma

Video Endoscopic Sequence 2 of 6.

Endoscopic view of Colonic lymphoma

One month after, a follow up endoscopy is performed showing the images and video clips in this sequence and below.

Extensive lesions are seen from the rectosigmoid junction to the hepatic flexure, this image shows the rectosigmoid junction which display transitional tissues between normal and pathological.

 

Colonic lymphoma

Video Endoscopic Sequence 3 of 6.

Colonoscopy of Colonic lymphoma

Extensive ulceration are displayed.

The colon is a rare location for gastrointestinal
non-Hodgkin's lymphoma.

 

Video Endoscopic Sequence 4 of 6.

Image and video clip of Colonic lymphoma

Hepatic flexure shows transitional tissues between pathological and normal.

Primary colorectal lymphoma is an infrequent disease of unknown origin and with a growing incidence. Differentiation be-tween primary lymphoma and secondary colorectal involvement is of great therapeutic and prognostic importance. The diagnosis must always be based on histological findings. Different forms of presentation have been described, though all are nonspecific. While full agreement on the best management approach for colorectal lymphoma is lacking, surgical resection is usually the treatment of choice.

 

Colonic lymphoma

Video Endoscopic Sequence 5 of 6.

Colonic lymphoma

Since Billroth first described a gastrointestinal lymphoma in 1871, numerous lymphoid tumors have been reported in virtually all parts of the digestive tract. Lymphomas may appear in the colon as primary malignancies or as a manifestation of systemic disease. Differentiation between primary colonic lymphoma (PCL) and secondary colorectal involvement is of great therapeutic and prognostic importance.

 

Colonc lymphoma

Video Endoscopic Sequence 6 of 6.

Colonic lymphoma

This image as well as the video clip display the extensive ulceration across of a large segment from the rectosigmoid junction to the hepatic flexure.

 

Linfoma Cecum

Video Endoscopic Sequence 1 of 10.

Non Hodking Linfoma of the Cecum

This 63 year-old male, presented abdominal pain, the ultrasound and the cat scan displayed radiologic findings consistent with intussecion of the terminal Terminal ileum, after that was referred to our endoscopic unit.

 

Linfoma of the Cecum

 

Colonoscopic view of Colonic lymphoma

Video Endoscopic Sequence 2 of 10.

Colonoscopic view of Colonic lymphoma

Colonoscopy displays an encapsulated mass. The present study describes a case of cecal lymphoma without involvement of any other organ.

 

Video colonoscopy of a Colonic lymphoma

Video Endoscopic Sequence 3 of 10.

Video colonoscopy of a Colonic lymphoma

Primary colorectal lymphoma is an infrequent disease of unknown origin and with a growing incidence. Differentiation be-tween primary lymphoma and secondary colorectal involvement is of great therapeutic and prognostic importance. The diagnosis must always be based on histological findings. Different forms of presentation have been described, though all are nonspecific. While full agreement on the best management approach for colorectal lymphoma is lacking, surgical resection is usually the treatment of choice.

 

 

Colon lymphoma

Video Endoscopic Sequence 4 of 10.

Colon lymphoma

Gastrointestinal tract (particularly the small intestine and stomach) is the most common location of extra-lymph-node non-Hodgkin lymphomas. The colon is affected in only 5-20% of cases. In this context, primary colonic lymphoma (PCL) accounts for 0.2-0.5% of all neoplasms in this location, with a prevalence of 0.02 per 100,000 inhabitants . In the colon, the cecum is the most frequently affected segment, followed by the rectum. This is probably explained by the more abundant lymphatic tissue found in these regions. In 5% of cases synchronic lesions and multiple lymphomatous polyps are also observed.

 

Colon lymphoma

Video Endoscopic Sequence 5 of 10.

Image and video clip of Colon lymphoma

Colonoscopy confirmed the presence of an extensive mass in the cecal region, and multiple biopsies were collected. Histology reported a large B cell lymphoma with a high proliferation index. Neck, chest and abdominal computed tomography scans and an ultrasonographic study of disease spread revealed no additional lesions. A bone marrow study proved normal.

 

Colon lymphoma

Video Endoscopic Sequence 6 of 10.

Image and video clip of Colon lymphoma

Clinical features

The most common symptoms of colonic lymphoma are abdominal pain, nausea, vomiting, weight loss, abdominal mass, change in bowel habits, hematochezia obstruction, intussusceptions, and acute peritonitis due to intestinal perforation. The lack of specific complaints and the rarity of intestinal obstruction probably accounts for the delay in diagnosis. These bulky masses can usually be palpated by simple physical examination and viewed by ultrasonography.

 

Colon lymphoma

Video Endoscopic Sequence 7 of 10.

Image and video clip of Colon lymphoma

Primary colonic lymphomas are rare; the cecum is the most common site of occurrence. Early diagnosis may prevent intestinal perforation; however, the diagnosis is often delayed in most cases. Surgical resection is the mainstay of treatment for localized primary lymphomas, followed by postoperative chemotherapy. Those with limited stage disease may enjoy prolonged survival when treated with aggressive chemotherapy. Surgery alone can be considered as an adequate treatment for patients with low-grade NHL disease that does not infiltrate beyond the sub mucosa. Although resection plays an important role in the local control of the disease and in preventing bleeding and/or perforation, it rarely eradicates the lymphoma by itself.

 

Colon lymphoma

Video Endoscopic Sequence 8 of 10.

Image and video clip of Colon lymphoma

Most authors agree that the initial treatment of PCL should include surgical resection, since this affords prognostic information, avoids complications (bleeding, occlusion, etc.), and allows healing of the disease in some cases. Since the cecum is most commonly affected, a right-side colectomy is usually indicated. It is advisable that a resection of regional lymph nodes be included, since these are usually found to be affected in the histological study, and a liver biopsy is mandatory. Laparoscopic resection of colon tumors has been shown to meet standard oncological criteria, and further offers important advantages in terms of both morbidity and mortality, particularly in elderly patients or individuals with relevant concomitant diseases.

 

Colon lymphoma

Video Endoscopic Sequence 9 of 10.

Macroscopic Image of a Colon lymphoma

 

Colon lymphoma

Video Endoscopic Sequence 10 of 10.

Macroscopic Image of a Colon lymphoma

Video Endoscopic Sequence 1 of 16.

Non-Hodgkin's Lymphoma of the Colon.

77 year old- male, presented with abdominal pain in the right iliac fossa and constipation since three months.

Colonoscopy shows large ulcerated mass, which observed irregular with some villi. The surgical specimen shows the extension from the terminal ileum to the ascending colon. The surgical report the surgeon found signs of perforation.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 2 of 16.

Video Colonoscopy of Non-Hodgkin's Lymphoma of the Colon.

Primary lymphoma of the colon is a rare tumor of the gastrointestinal (GI) tract and comprises only 0.2-1.2% of all colonic malignancies. The most common variety of colonic lymphoma is non-Hodgkin's lymphoma (NHL). The GI tract is the most frequently involved site, accounting for 30-40% of all extra nodal lymphomas, approximately 4-20 % of which are NHL. The stomach is the most common location of GI lymphomas, followed by the small intestine. Early diagnosis may prevent intestinal perforation; however, the diagnosis is often delayed in most cases.

 

 

Lymphoma of the Colon.

Video Endoscopic Sequence 3 of 16.

Video Colonoscopy of Non-Hodgkin's Lymphoma of the Colon.

Therapeutic approaches described in two
subsets include: Radical tumor resection (hemicolectomy)
plus multi-agent chemotherapy (polychemotherapy)
in early stage patients, biopsy plus multidrug
chemotherapy in advanced stage patients. Radiotherapy is
reserved for specific cases; surgery alone can be
considered as an adequate treatment for patients with
low -grade NHL disease that does not infiltrate beyond the
sub mucosa. Although resection plays an important role in
the local control of the disease and in preventing bleeding
and/or perforation, it rarely eradicates the lymphoma by
itself. Those with limited stage disease may enjoy
prolonged survival when treated with aggressive
chemotherapy.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 4 of 16.

Macroscopic Image of a Colon lymphoma

Surgical specimen shows the terminal ileum, cecum and
part of the ascending colon.

Non-Hodgkin lymphoma "B" (immunohistochemistry),

 

Lymphoma of the Colon.

Video Endoscopic Sequence 5 of 16.

Macroscopic Image of a Colon lymphoma

The ileocecal region, with invasion of the appendix
cecal mesentery, mesocolon and ileocolic lymph nodes of
mucosa-associated type malt.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 6 of 16.

Macroscopic Image of a Colon lymphoma

When the surgical specimen was cut, shows ulcerated
tumor, which involved all the cecum in an area of 9 cm.
long and with a perimeter of 10 cm. the tumor infiltrated
the entire wall to the fat with nodular ileocolic junction.
The cecal appendix measured 6x1.5 cm with tumor
infiltration to the fat.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 7 of 16.

Macroscopic Image of a Colon lymphoma

According to the report of the pathologist, surgical limits
were reported free of malignant infiltration.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 8 of 16.

Macroscopic Image of a Colon lymphoma

At the operating room shows part of the tumor within the surgical specimen.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 9 of 16.

Macroscopic Image of a Colon lymphoma

Intestinal lymphomas differ from gastric lymphomas not
only in pathology, but also in their clinical features,
treatment, and prognosis. The gross appearance of the
tumor may be annular or just a thickened bowel wall. The
majority of the colon lymphomas are single (86%), can be
multiple or diffuse in nature. The term, "primary intestinal
lymphoma" includes some particular entities: The western
type, immunoproliperative small intestinal disease (IPSID
or Mediterranean lymphoma), the enteropathy- associated
T-cell lymphoma, and the childhood type. The western type
is an uncommon malignancy with a challenging differential
diagnosis and an urgent need for therapy. In Western
countries, almost all primary colorectal lymphomas are
of B-cell lineage whereas they tend to be of T-cell lineage
in the East. B-cell lymphomas are more common in older
people than are T-cell lymphomas.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 10 of 16.

Macroscopic Image of a Colon lymphoma

Lymphoma of the Colon.

Video Endoscopic Sequence 11 of 16.

At the microscopic level there are neoplasia of small
lymphocytes that infiltrating the ileal and cecal mucosa
with lymphoepithelial lesion. There
infiltration of the muscle wall, cecal appendix, fat
ileocolic and mesenteric lymph nodes in the region and
coming node separately. The ileal mucosa and
ascending colon tumor are not normal.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 12 of 16.

Endoscopic Biopsies of our patient

Histology of MALT lymphoma and diffuse large B-cell lymphoma of the colon.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 13 of 16.

Microscpoic photograph showing lymphoma cells infiltrating the mucosa and submucosa of the colon.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 14 of 16.

Lymphoma of the Colon.

Video Endoscopic Sequence 15 of 16.

Immunostaining of MALT lymphoma and diffuse large B-cell lymphoma of the colon.

 

Lymphoma of the Colon.

Video Endoscopic Sequence 16 of 16.

Immunostaining of MALT lymphoma and diffuse large B-cell lymphoma of the colon.

 

2000 - 2017 gastrointestinalatlas.com
San Salvador, El Salvador | Contact