Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy

Sung Ik Pyeon; Geun Am Song; Dong Hoon Baek; Gwang Ha Kim; Bong Eun Lee; Seong Jun Lee; Jung Bin Yoon; Sung Yong Han; Do Youn Park

doi:10.4166/kjg.2017.69.2.139

Journal List > Korean J Gastroenterol > v.69(2) > 1007616

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Pyeon, Song, Baek, Kim, Lee, Lee, Yoon, Han, and Park: Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy

Case Report

Korean J Gastroenterol 2017;69(2):139-142.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.2.139

Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy

Sung Ik Pyeon, Geun Am Song, Dong Hoon Baek, Gwang Ha Kim, Bong Eun Lee, Seong Jun Lee, Jung Bin Yoon, Sung Yong Han, Do Youn Park¹

Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

¹Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

Correspondence to: Geun Am Song, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: +82-51-240-7869, Fax: +82-51-244-8180, E-mail: gasong@pusan.ac.kr

Received 5 December 2016 Revised 30 December 2016 Accepted 30 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The gastrointestinal tract is the most common site of extranodal non-Hodgkin lymphoma. However, the incidence of primary rectal lymphoma is extremely rare. Among the primary gastrointestinal lymphomas, follicular lymphoma has been described as a rare disease. It is difficult to diagnose rectal lymphoma due to its variable growth patterns and inadequate biopsies. Majority of patients with rectal lymphoma have nonspecific symptoms or negative biopsies, often delaying the diagnosis. Our patient is a 62-year-old female. Two sessile and smooth subepithelial lesions with a yellowish normal mucosa were found on a screening colonoscopy. The initial mucosal biopsy finding was chronic inflammation, but we were highly suspicion of malignancy; we performed an endoscopic mucosal resection. Herein, we present a rare case of rectal follicular lymphoma diagnosed by endoscopic mucosal resection with a literature review.

Keywords: Follicular lymphoma, Rectum, Subepithelial tumor

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Fig. 1.

Colonoscopic findings. (A) 4 mm subepithelial lesion on 3cm from anal verge, 3 mm subepitheliallesion on 2 cm from anal verge. (B) Smooth subepithelial lesion with yellowish colored normal mucosa on 3 cm from anal verge.

Fig. 2.

EUS findings. 0.4×0.3 cm homogenous hypoechoic mass invaded second to third layer.

Fig. 3.

Histologic findings. (A) Tumor is located in submucosa and invades into mucosa. The neoplastic follicles are poorly defined and show diffuse effacement (H&E, ×40). (B) Tumor cells are composed of centrocytes and centroblasts (H&E, ×400).

Fig. 4.

Histologic findings. (A) Immunohistochemical staining for CD20. Tumor cells are positive for CD20 (×200). (B) Immunohistochemical staining for CD21 shows expanding follicular dendritic cell meshworks (×200).

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