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Clinical Journal of Gastroenterology

, Volume 10, Issue 2, pp 147–153 | Cite as

Follicular lymphoma-related colitis resembling ulcerative colitis

  • Takahiro ZendaEmail author
  • Noriharu Nakagawa
  • Hiroyuki Maruyama
  • Tamao Endo
  • Kotaro Higashi
  • Junpei Yamamoto
  • Keigo Komai
  • Kishichiro Watanabe
  • Ichiro Araki
Case Report

Abstract

Among the various manifestations of colonic involvement in malignant lymphomas, an ulcerative colitis-like appearance is rare. Herein, we describe a case in which extranodal colonic involvement resembled ulcerative colitis in a patient with advanced follicular lymphoma. A 59-year-old Japanese man with diarrhea and body weight loss was referred to our hospital. Computed tomography (CT) revealed systemic lymphadenopathy, splenomegaly, and thickening of the sigmoid colon and rectum walls. 18F-fluorodeoxy-glucose positron emission tomography (18F-FDG-PET/CT) revealed intense tubular 18F-FDG accumulation extending from the rectum to the colon at the hepatic flexure and much weaker accumulation in the systemic lymph nodes, bone marrow, and spleen. The isotope-enriched areas had an ulcerative colitis-like appearance as shown via colonoscopy. The patient was ultimately diagnosed with follicular lymphoma (stage IV A, grade 1) based on a pathological examination of the neck lymph nodes, iliac bone marrow, and colon. After six courses of chemotherapy (R-CHOP), 18F-FDG-PET/CT confirmed complete remission of the lymphoma including the colonic lesion. This is presumably the first case of ulcerative-like colitis caused by a follicular lymphoma. As a novel approach, the lymphoma-related colitis was detected by comparing the pathology results and the 18F-FDG-PET/CT results.

Keywords

Follicular lymphoma Lymphoma-related colitis Ulcerative colitis 18F-FDG-PET/CT Lymphomatous colitis 

Notes

Compliance with ethical standards

Conflict of Interest:

None of the authors have received any grant associated with this case report. All authors (Takahiro Zenda, Noriharu Nakagawa, Hiroyuki Maruyama, Tamao Endo, Kotaro Higashi, Junpei Yamamoto, Keigo Komai, Kishichiro Watanabe, Ichiro Araki) declare that they have no conflict of interest.

Human Rights:

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent:

Informed consent was obtained from the patient for being reported in this journal.

References

  1. 1.
    Quayle FJ, Lowney JK. Colorectal lymphoma. Clin Colon Rectal Surg. 2006;19:49–53.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Misdraji J, Harris NL, Hasserjian RP, et al. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol. 2011;35:1255–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Shia J, Teruya-Feldstein J, Pan D, et al. Primary follicular lymphoma of the gastrointestinal tract: a clinical and pathologic study of 26 cases. Am J Surg Pathol. 2002;26:216–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Isomoto H, Furusu H, Onizuka Y, et al. Colonic involvement by adult T-cell leukemia/lymphoma mimicking ulcerative colitis. Gastrointest Endosc. 2003;58:805–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Kakati BR, Krishna SG, Dang SM, et al. Colonic perforation following polypectomy of a gastrointestinal follicular lymphoma masquerading as a colon polyp. J Gastrointest Cancer. 2012;43:382–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee HJ, Han JK, Kim TK, et al. Primary colorectal lymphoma: spectrum of imaging findings with pathologic correlation. Eur Radiol. 2002;12:2242–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Ciarallo A, Makis W, Derbekyan V. Primary peripheral T-cell lymphoma of the colon mimics inflammatory bowel disease: a potential pitfall with F-18 FDG PET/CT imaging. Clin Nucl Med. 2011;36:e61–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Godoy P, Calderaro DC. Non-Hodgkinʼs lymphoma of the colon and ulcerative colitis. Case report. Arq Gastroenterol. 1999;36:85–9.PubMedGoogle Scholar
  9. 9.
    Payne S, Phillips M, Reffitt D, et al. An unusual case of colitis. Gut. 2004;53:1824.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sagar S, Selby P, Sloane J, et al. Colorectal lymphoma simulating inflammatory colitis and diagnosed by immunohistochemistry. Postgrad Med J. 1986;62:51–3.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Koksal AS, Taskiran I, Kalkan IH, et al. A rare endoscopic appearance of primary gastrointestinal mantle cell lymphoma resembling ulcerative colitis. Bratisl Lek Listy. 2014;115:800–1.PubMedGoogle Scholar
  12. 12.
    Tamura S, Ohkawauchi K, Yokoyama Y, et al. Non-multiple lymphomatous polyposis form of mantle cell lymphoma in the gastrointestinal tract. J Gastroenterol. 2004;39:995–1000.CrossRefPubMedGoogle Scholar
  13. 13.
    García Ortiz LM, Jaume Anselmi F, Ramírez Rivera J, et al. Non-Hodgkin’s lymphoma presenting as ulcerative colitis. Bol Asoc Med P R. 2006;98:140–3.PubMedGoogle Scholar
  14. 14.
    Federman J, Goldstein ME, Weingarten B. Malignant lymphoma of over fifteen yearsʼ duration masquerading as ulcerative colitis. Am J Roentgenol Radium Ther Nucl Med. 1963;89:771–8.PubMedGoogle Scholar
  15. 15.
    Friedman HB, Silver GM, Brown CH. Lymphoma of the colon simulating ulcerative colitis: report of four cases. Am J Dig Dis. 1968;13:910–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Carbone PP, Kaplan HS, Musshoff K, et al. Report of the committee on Hodgkin’s disease staging classification. Cancer Res. 1971;31:1860–1.PubMedGoogle Scholar
  17. 17.
    Federico M, Bellei M, Marcheselli L, et al. Follicular lymphoma international prognostic index 2: a new prognostic index for follicular lymphoma developed by the international follicular lymphoma prognostic factor project. J Clin Oncol. 2009;27:4555–62.CrossRefPubMedGoogle Scholar
  18. 18.
    Iwamuro M, Okada H, Takata K, et al. Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement. World J Gastroenterol. 2012;18:6427–36.CrossRefGoogle Scholar
  19. 19.
    Fallah M, Liu X, Ji J, et al. Autoimmune diseases associated with non-Hodgkin lymphoma: a nationwide cohort study. Ann Oncol. 2014;25:2025–30.CrossRefPubMedGoogle Scholar
  20. 20.
    Das CJ, Makharia GK, Kumar R, et al. PET/CT colonography: a novel non-invasive technique for assessment of extent and activity of ulcerative colitis. Eur J Nucl Med Mol Imaging. 2010;37:714–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Parbo P, Stribolt K, Rittig CS, et al. Active ulcerative colitis diagnosed by 18F-FDG PET/CT in an anti-TNF alpha treated patient with no visible luminal lesions on colonoscopy. Int J Colorectal Dis. 2014;29:643–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Kumar R, Xiu Y, Potenta S, et al. 18F-FDG PET for evaluation of the treatment response in patients with gastrointestinal tract lymphomas. J Nucl Med. 2004;45:1796–803.PubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2016

Authors and Affiliations

  • Takahiro Zenda
    • 1
    Email author
  • Noriharu Nakagawa
    • 1
    • 5
  • Hiroyuki Maruyama
    • 6
  • Tamao Endo
    • 2
  • Kotaro Higashi
    • 2
  • Junpei Yamamoto
    • 3
  • Keigo Komai
    • 4
  • Kishichiro Watanabe
    • 4
    • 7
  • Ichiro Araki
    • 1
  1. 1.Department of Internal MedicineAsanogawa General HospitalKanazawaJapan
  2. 2.Department of RadiologyAsanogawa General HospitalKanazawaJapan
  3. 3.Department of OtolaryngologyAsanogawa General HospitalKanazawaJapan
  4. 4.Department of PathologyAsanogawa General HospitalKanazawaJapan
  5. 5.Department of HematologyGraduate School of Medical Science, Kanazawa UniversityKanazawaJapan
  6. 6.Department of Internal MedicineKeijyu Kanazawa HospitalKanazawaJapan
  7. 7.Watanabe’s Consultancy for Pathological DiagnosisKanazawaJapan

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