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

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

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.

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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.
kjg-69-139f1.tif
Fig. 2.
EUS findings. 0.4×0.3 cm homogenous hypoechoic mass invaded second to third layer.
kjg-69-139f2.tif
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).
kjg-69-139f3.tif
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).
kjg-69-139f4.tif
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