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Collision tumor of low-grade B-cell lymphoma and adenocarcinoma with tuberculosis in the colon: a case report and literature review.

Lin HH, Jiang JK, Lin JK - World J Surg Oncol (2014)

Bottom Line: Moreover, concurrent tuberculosis infection in the resected colon was proven by the presence of positive results obtained with polymerase chain reaction analysis of the mycobacterial DNA.Furthermore, collisions of these different entities are also extremely unusual.The accurate clinical determination of the dominant tumor and a timely follow-up are required for the proper treatment of these cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No 201, Sec, 2, Shih-Pai Road, Taipei 11217, Taiwan. jklin@vghtpe.gov.tw.

ABSTRACT
This report presents a case of collision tumors of low-grade B-cell lymphoma and adenocarcinoma in the sigmoid colon of an 81-year-old man. All surgically resected regional mesenteric lymph nodes were found to be occupied by low-grade B-cell lymphoma, and one lymph node showed the presence of adenocarcinoma. Low-grade B-cell lymphoma was also observed in the resected spleen. Moreover, concurrent tuberculosis infection in the resected colon was proven by the presence of positive results obtained with polymerase chain reaction analysis of the mycobacterial DNA. Systemic chemotherapy was administered for advanced colon cancer with lung metastasis, and anti-tuberculosis treatment was also prescribed. The occurrence of synchronous lymphoma and adenocarcinoma of the colorectal region is rare. Furthermore, collisions of these different entities are also extremely unusual. The accurate clinical determination of the dominant tumor and a timely follow-up are required for the proper treatment of these cases.

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The spleen was infiltrated by low-grade B-cell lymphoma with the proliferation of small-to-medium-sized cells. Hematoxylin and eosin, original magnification, ×100.
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Figure 3: The spleen was infiltrated by low-grade B-cell lymphoma with the proliferation of small-to-medium-sized cells. Hematoxylin and eosin, original magnification, ×100.

Mentions: An 81-year-old man presented to the Department of Chest Medicine as an outpatient with a chronic dry cough persisting for 1 month. There were no other systemic symptoms, excluding hypertension and benign prostate hyperplasia. Chest radiography revealed a 3.2-cm nodule in the right middle lung field. Bronchoscopic biopsy was performed, and the pathological examination revealed adenocarcinoma, which was considered to be colorectal in origin, as proved by a positive immunostaining reaction for cytokeratin 20 (Figure 1A) and caudal-related homeodomain transcription factor 2 (Figure 1B) as well as immunostaining reaction for cytokeratin 7 (Figure 1C) and thyroid transcription factor-1 (Figure 1D). The patient was then referred to the outpatient Department of Colorectal Surgery. After admission, a series of analyses were performed. The general examination was unremarkable, with no lymphadenopathy, and laboratory studies revealed a hemoglobin concentration of 11.9 g/dL, a white blood cell count of 5,800 cells/μL, and a platelet count of 154,000 cells/μL. Renal and liver function tests were normal, and hepatitis markers were negative. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 214 ng/mL and 1.21 U/mL, respectively. A complete colonoscopy revealed an annular ulcerative lesion in the sigmoid colon (25 cm above the anal verge). Biopsy of the tumor was performed, which revealed a moderately differentiated colon adenocarcinoma. Computed tomography of the abdomen and pelvis revealed mesenteric lymphadenopathies associated with a mass in the sigmoid colon (Figure 2A, arrow). There was no liver metastasis. Computed tomography of the thorax revealed a 3.2-cm nodule in the right middle lung field that was consistent with lung metastasis (Figure 2B, arrow). The patient underwent anterior resection associated with regional lymphadenectomy, with the pathological assessment of the resected specimen revealing a collision tumor consisting of a moderately differentiated adenocarcinoma extending through the muscularis propria and low-grade B-cell lymphoma. Extramural vascular invasion of the adenocarcinoma cells was present. Interestingly, there were several granulomatous lesions on the resected sigmoid colon. Acid-fast staining and polymerase chain reaction analysis of mycobacterial DNA revealed positive findings. Microscopic evaluation of the 19 regional lymph nodes in the mesentery of the resected colon showed diffuse infiltration of low-grade B-cell lymphoma in the lymph node architecture. In one lymph node, metastasis of adenocarcinoma was also present. According to immunohistochemistry, the cells were positive for cluster of differentiation (CD) 20, B-cell lymphoma (Bcl)-2, and CD10 (weak), and negative for CD3, CD5, CD23, Bcl-6, terminal deoxynucleotidyl transferase, and cyclin D1. The proliferation fraction (MIB-1 immunostaining) was approximately 15%. The morphological and immunohistochemical findings were used to confirm the diagnosis of synchronous presentation of low-grade B-cell lymphoma and colon adenocarcinoma within the sigmoid colon tumor and mesenteric lymph nodes. Furthermore, microscopic examination of the spleen revealed infiltration of the specimen by low-grade B-cell lymphoma with proliferation of small to medium-sized cells (Figure 3). K-RAS and B-RAF genetic mutations were evaluated in the primary tumor DNA after microdissection, and both genes were determined to be the wild type. Three weeks after surgery, the patient was scheduled to undergo a bone marrow biopsy for lymphoma staging, but he declined because of his advanced age and general poor condition.


Collision tumor of low-grade B-cell lymphoma and adenocarcinoma with tuberculosis in the colon: a case report and literature review.

Lin HH, Jiang JK, Lin JK - World J Surg Oncol (2014)

The spleen was infiltrated by low-grade B-cell lymphoma with the proliferation of small-to-medium-sized cells. Hematoxylin and eosin, original magnification, ×100.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4020310&req=5

Figure 3: The spleen was infiltrated by low-grade B-cell lymphoma with the proliferation of small-to-medium-sized cells. Hematoxylin and eosin, original magnification, ×100.
Mentions: An 81-year-old man presented to the Department of Chest Medicine as an outpatient with a chronic dry cough persisting for 1 month. There were no other systemic symptoms, excluding hypertension and benign prostate hyperplasia. Chest radiography revealed a 3.2-cm nodule in the right middle lung field. Bronchoscopic biopsy was performed, and the pathological examination revealed adenocarcinoma, which was considered to be colorectal in origin, as proved by a positive immunostaining reaction for cytokeratin 20 (Figure 1A) and caudal-related homeodomain transcription factor 2 (Figure 1B) as well as immunostaining reaction for cytokeratin 7 (Figure 1C) and thyroid transcription factor-1 (Figure 1D). The patient was then referred to the outpatient Department of Colorectal Surgery. After admission, a series of analyses were performed. The general examination was unremarkable, with no lymphadenopathy, and laboratory studies revealed a hemoglobin concentration of 11.9 g/dL, a white blood cell count of 5,800 cells/μL, and a platelet count of 154,000 cells/μL. Renal and liver function tests were normal, and hepatitis markers were negative. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 214 ng/mL and 1.21 U/mL, respectively. A complete colonoscopy revealed an annular ulcerative lesion in the sigmoid colon (25 cm above the anal verge). Biopsy of the tumor was performed, which revealed a moderately differentiated colon adenocarcinoma. Computed tomography of the abdomen and pelvis revealed mesenteric lymphadenopathies associated with a mass in the sigmoid colon (Figure 2A, arrow). There was no liver metastasis. Computed tomography of the thorax revealed a 3.2-cm nodule in the right middle lung field that was consistent with lung metastasis (Figure 2B, arrow). The patient underwent anterior resection associated with regional lymphadenectomy, with the pathological assessment of the resected specimen revealing a collision tumor consisting of a moderately differentiated adenocarcinoma extending through the muscularis propria and low-grade B-cell lymphoma. Extramural vascular invasion of the adenocarcinoma cells was present. Interestingly, there were several granulomatous lesions on the resected sigmoid colon. Acid-fast staining and polymerase chain reaction analysis of mycobacterial DNA revealed positive findings. Microscopic evaluation of the 19 regional lymph nodes in the mesentery of the resected colon showed diffuse infiltration of low-grade B-cell lymphoma in the lymph node architecture. In one lymph node, metastasis of adenocarcinoma was also present. According to immunohistochemistry, the cells were positive for cluster of differentiation (CD) 20, B-cell lymphoma (Bcl)-2, and CD10 (weak), and negative for CD3, CD5, CD23, Bcl-6, terminal deoxynucleotidyl transferase, and cyclin D1. The proliferation fraction (MIB-1 immunostaining) was approximately 15%. The morphological and immunohistochemical findings were used to confirm the diagnosis of synchronous presentation of low-grade B-cell lymphoma and colon adenocarcinoma within the sigmoid colon tumor and mesenteric lymph nodes. Furthermore, microscopic examination of the spleen revealed infiltration of the specimen by low-grade B-cell lymphoma with proliferation of small to medium-sized cells (Figure 3). K-RAS and B-RAF genetic mutations were evaluated in the primary tumor DNA after microdissection, and both genes were determined to be the wild type. Three weeks after surgery, the patient was scheduled to undergo a bone marrow biopsy for lymphoma staging, but he declined because of his advanced age and general poor condition.

Bottom Line: Moreover, concurrent tuberculosis infection in the resected colon was proven by the presence of positive results obtained with polymerase chain reaction analysis of the mycobacterial DNA.Furthermore, collisions of these different entities are also extremely unusual.The accurate clinical determination of the dominant tumor and a timely follow-up are required for the proper treatment of these cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No 201, Sec, 2, Shih-Pai Road, Taipei 11217, Taiwan. jklin@vghtpe.gov.tw.

ABSTRACT
This report presents a case of collision tumors of low-grade B-cell lymphoma and adenocarcinoma in the sigmoid colon of an 81-year-old man. All surgically resected regional mesenteric lymph nodes were found to be occupied by low-grade B-cell lymphoma, and one lymph node showed the presence of adenocarcinoma. Low-grade B-cell lymphoma was also observed in the resected spleen. Moreover, concurrent tuberculosis infection in the resected colon was proven by the presence of positive results obtained with polymerase chain reaction analysis of the mycobacterial DNA. Systemic chemotherapy was administered for advanced colon cancer with lung metastasis, and anti-tuberculosis treatment was also prescribed. The occurrence of synchronous lymphoma and adenocarcinoma of the colorectal region is rare. Furthermore, collisions of these different entities are also extremely unusual. The accurate clinical determination of the dominant tumor and a timely follow-up are required for the proper treatment of these cases.

Show MeSH
Related in: MedlinePlus