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A Case of Rectal Squamous Cell Carcinoma with Metachronous Diffuse Large B Cell Lymphoma in an HIV-Infected Patient.

Choi H, Lee HW, Ann HW, Kim JK, Kang HP, Kim SW, Ku NS, Han SH, Kim JM, Choi JY - Infect Chemother (2014)

Bottom Line: Follow-up imaging showed increased uptake at the rectum, previously treated as lymphoma.Repeated biopsy was performed and squamous cell carcinoma of the rectum was reported.After concurrent chemoradiation therapy, curative resection was performed.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Diffuse large B cell lymphoma (DLBCL) is one of the most common acquired immune deficiency syndrome (AIDS)-defining malignancies among human immunodeficiency virus-infected patients, and rectal cancer has recently emerged as a prevalent non-AIDS-defining malignancy. We report a case of rectal squamous cell carcinoma that was metachronous with DLBCL in an HIV-infected patient who was receiving highly active antiretroviral therapy. The patient was diagnosed with DLBCL and showed complete remission after chemotherapy. Follow-up imaging showed increased uptake at the rectum, previously treated as lymphoma. Repeated biopsy was performed and squamous cell carcinoma of the rectum was reported. After concurrent chemoradiation therapy, curative resection was performed.

No MeSH data available.


Related in: MedlinePlus

(A) 75% circumferential ulceroinfiltrative lesion in the rectum. (B) H&E stain (×400): Diffuse large B-cell lymphoma. (C) Immunohistochemical stain: CD 20 positive.
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Figure 1: (A) 75% circumferential ulceroinfiltrative lesion in the rectum. (B) H&E stain (×400): Diffuse large B-cell lymphoma. (C) Immunohistochemical stain: CD 20 positive.

Mentions: A 51-year-old homosexual male with 10-year history of HIV infection presented to the emergency department with complaints of repeated bloody stool (three instances). He had received HAART, but his HAART treatment regimen had to be altered several times due to adverse events, poor adherence and virologic failure. He was taking lamivudine, stavudine, lopinavir-ritonavir and abacavir at the time of admission. He had no history of opportunistic infections since his diagnosis in 1997. He denied any symptoms, including fevers, chills, night sweats or weight loss, except hematochezia. On physical examination, the abdomen was soft and there were no palpable masses or tenderness. He had a notable mass on digital rectal examination. His CD4+ T cell count was 116/mm3, and his HIV viral load was 2,730 copies/mL. Epstein Barr virus (EBV) polymerase chain reaction (PCR) showed 27,750 copies/mL. Sigmoidoscopy demonstrated a 75% circumferential ulceroinfiltrative lesion in the rectum and a biopsy was performed (Fig. 1A). Pathologic diagnosis was diffuse large B-cell lymphoma with CD20 (+), CD3 (-), cytokeratin (-), and Ki-67 (90%) (Fig. 1B and C). The staging work-up including a bone marrow study revealed lymphoma of the anorectum, nasopharynx, upper neck lymph node, and bone marrow with Ann Arbor stage IV in July 2007. Chemotherapy was initiated with a regimen of rituximab combined with etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone for 4 cycles, and vincristine, doxorubicin, cyclophosphamide, and for 2 cycles. The patient achieved complete remission in February 2008.


A Case of Rectal Squamous Cell Carcinoma with Metachronous Diffuse Large B Cell Lymphoma in an HIV-Infected Patient.

Choi H, Lee HW, Ann HW, Kim JK, Kang HP, Kim SW, Ku NS, Han SH, Kim JM, Choi JY - Infect Chemother (2014)

(A) 75% circumferential ulceroinfiltrative lesion in the rectum. (B) H&E stain (×400): Diffuse large B-cell lymphoma. (C) Immunohistochemical stain: CD 20 positive.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4285004&req=5

Figure 1: (A) 75% circumferential ulceroinfiltrative lesion in the rectum. (B) H&E stain (×400): Diffuse large B-cell lymphoma. (C) Immunohistochemical stain: CD 20 positive.
Mentions: A 51-year-old homosexual male with 10-year history of HIV infection presented to the emergency department with complaints of repeated bloody stool (three instances). He had received HAART, but his HAART treatment regimen had to be altered several times due to adverse events, poor adherence and virologic failure. He was taking lamivudine, stavudine, lopinavir-ritonavir and abacavir at the time of admission. He had no history of opportunistic infections since his diagnosis in 1997. He denied any symptoms, including fevers, chills, night sweats or weight loss, except hematochezia. On physical examination, the abdomen was soft and there were no palpable masses or tenderness. He had a notable mass on digital rectal examination. His CD4+ T cell count was 116/mm3, and his HIV viral load was 2,730 copies/mL. Epstein Barr virus (EBV) polymerase chain reaction (PCR) showed 27,750 copies/mL. Sigmoidoscopy demonstrated a 75% circumferential ulceroinfiltrative lesion in the rectum and a biopsy was performed (Fig. 1A). Pathologic diagnosis was diffuse large B-cell lymphoma with CD20 (+), CD3 (-), cytokeratin (-), and Ki-67 (90%) (Fig. 1B and C). The staging work-up including a bone marrow study revealed lymphoma of the anorectum, nasopharynx, upper neck lymph node, and bone marrow with Ann Arbor stage IV in July 2007. Chemotherapy was initiated with a regimen of rituximab combined with etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone for 4 cycles, and vincristine, doxorubicin, cyclophosphamide, and for 2 cycles. The patient achieved complete remission in February 2008.

Bottom Line: Follow-up imaging showed increased uptake at the rectum, previously treated as lymphoma.Repeated biopsy was performed and squamous cell carcinoma of the rectum was reported.After concurrent chemoradiation therapy, curative resection was performed.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Diffuse large B cell lymphoma (DLBCL) is one of the most common acquired immune deficiency syndrome (AIDS)-defining malignancies among human immunodeficiency virus-infected patients, and rectal cancer has recently emerged as a prevalent non-AIDS-defining malignancy. We report a case of rectal squamous cell carcinoma that was metachronous with DLBCL in an HIV-infected patient who was receiving highly active antiretroviral therapy. The patient was diagnosed with DLBCL and showed complete remission after chemotherapy. Follow-up imaging showed increased uptake at the rectum, previously treated as lymphoma. Repeated biopsy was performed and squamous cell carcinoma of the rectum was reported. After concurrent chemoradiation therapy, curative resection was performed.

No MeSH data available.


Related in: MedlinePlus