Ahmed, A

Khan, A H

Shah, S H

Shaikh, H

English

eCommons@AKU

eCommons@AKUSection of Gastroenterology Department of MedicineFebruary 1993Lymphoma complicating ulcerative colitisS H. ShahAga Khan University, hasnain.alishah@aku.eduA H. KhanAga Khan UniversityH ShaikhAga Khan UniversityA AhmedAga Khan UniversityFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_med_gastroenterolPart of the Gastroenterology CommonsRecommended CitationShah, S. H., Khan, A. H., Shaikh, H., Ahmed, A. (1993). Lymphoma complicating ulcerative colitis. Journal of Pakistan MedicalAssociation, 43(2), 37-39.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_gastroenterol/205LYMPHOMA COMPLICATING ULCERATIVE COLITISPages with reference to book, From 37 To 39 Syed Hasnain Ali Shah, Abdul Haleem Khan, Ashfaque Ahmed ( Departments of Medicine, The Aga Khan UniversityHospital, Karachi. ) Hizbullah Shaikh ( Departments of Pathology, The Aga Khan University Hospital, Karachi. ) Carcinoma of large bowel is a relatively common complication of ulcerative colitis, whereas lymphomais rare. We report two cases with along history of ulcerative colitis complicated by Non- Hodgkin’slymphoma of the colon.CASE 1S.N., a 28 year old housewife presented to the Aga Khan University Hospital with increasingabdominal distension, pain and fever for 7 days. She had also noticed a vague mass in the left iliacfossa over the past one month prior to admission. She had ulcerative colitis for the past 10 years.Colonoscopy and biopsies done on a number of occasions demonstrated gross and histological featuresof ulcerative colitis. She had taken corticosteroids and mesalazine with partial benefit only. Onexamination she looked very unwell, cachectic and toxic. She was pale with no sign of jaundice orlymphadenopathy. Abdominal examination revealed ascites with vague mass in the left iliac fossa. Herhaemoglobin was 9.1 mg%, white cell count 11.6x109/1. platelets 122x109/1, ESR 8 mm/hr. BUN,serum creatinine were normal. Colonoscopy showed globular masses in sigmoid colon which werebiopsied. Histology revealed features of ulcerative colitis and Non-Hodgkin’s lymphoma (Figure 1 and2).Her ascites worsened and paracentesis of ascitic fluid confirmed lymphoma cells in the ascitic fluid.She developed bacterial infection and despite antibiotic therapy she died. A post mortem biopsy of leftiliac fossa mass confirmed the presence of lymphoma of gut infiltrating into the surrounding tissues(Figure 3).CASE 2ASA, a 70 year old male, presented to the Aga than University Hospital with four and half monthshistory of passage of loose stools with mucus but no blood. There were accompanying periumbilicaland left iliac fossa pains. There was no history of weight loss, malaise, fever or arthralgias. Pastmedical history and personal history were unremarkable. On examination he was pale without jaundiceor lymphadenopathy. Cardiovascular and chest examination were unremarkable. The abdomen wassoft, non-tender with no visceromegaly. Mobile masses which were firm and non-tender were palpable.Air contrast barium enema showed multiple ulcerations in descending and sigmoid colon withnarrowing at the rectosigmoid junction. Flexible sigmoidoscopy was done and biopsies taken showedfeatures of ulcerative proctitis with lymphomatous involvement (Figures 4, 5,6).Chestx-raywas normal. Computerized tomogram of the abdomen showed thickened loops of bowel andenlarged retroperitoneal lymph nodes. Hemoglobin was 10.7 gm%, ESR 40 mm/hr and IHA forarnebiasis was less than 1:16. This patient was given chiorambucil and prednisolone for his lymphoma.DISCUSSION Malignant lymphoma of the large gut complicating chronic ulcerative colitis is rare1. First ever reportof ulcerative colitis complicated by lymphoma appeared in 19282. There are less than thirty cases ofthis association reported in literature3-8. One case of malignant lymphoma arising in terminal ileum ofa patient with ileostomy after colectomy for ulcerative colitis has also been mentioned9 and a recentreport describes lymphoma occurring after colectomy and ileorectal anastomosis in ulcerative colitis10.Most lymphomas in this situation are of B cell lineage. It is important to exclude involvement of gut ina generalized lymphomatous process rather than this being a primary gut lymphoma. Therefore, thereshould be no evidence of lymphoma in bone marrow, lymph nodes except regional nodes, liver, spleenand other distant sites at least in the initial phases of disease11. Our cases were diagnosed quite late andyet it seems that there was no extra abdominal spread of disease and that this was primary gutlymphoma Case 1 is unusual in that she was a young female with left sided colonic involvementwhereas most cases reported in literature are middle aged males with right sided involvement ofcolon12. Our report further emphasises the importance of continued surveillance to detect rectallymphoma as well as carcinoma.REFERENCES 1. Edwards, P.C. and Truelove, S.C. The course and prognosis of ulcerative colitis. III. Complications.Gut, 1964;5:1-22.2. Bargen, 3.A. Chronic ulcerative colitis associated with malignant disease. Arch. Surg.. 1928;17:561-76.3. Bashiti, H.O. and Kraus, K.T. Histiocytic tymphoma in chronic ulcerative colitis. Cancer,1980;46:1695-700.4. Sataline, L.R., Mobley, EM. and Kirkham. W. Ulcerative colitis complicated by colonic lymphoma.Gastroenterology, 1963;44:342-47.5. Walker, F.C., and Weaver, J.P. Lymphosarcoma in ulcerative colitis. Br.J. Surg., 1964;51:475-77.6. Wychulis, A.R., Beahrs, O.H. and Woolner, LB. Malignant lymphoma of the colon.A study of 69cases. Arch. Surg., 1966;93:215-25.7. Nugent. F.W,, Zuberi, S., Bulan, M.B. and Legg, M.A. Colonic lympboma in ulcerative colitis:report of fourcases. L.abey Clin. Found. Bull., 1972:21:104-11.8. Parikh, N.K. Shah, P.M., Patel, S.M. and Chandra, D.D. Colonic lymphoma in ulcerative colitis (acase report). 3. Aasoc. Physns. India, 1973;21:713-16.9. Lewin, K.J., Ranchod, M. and Dorfman. R.F. Lymphoma of the gastrointestinal tract. Cancer,1978;42:693-707.10. Tears, J.P., Greenfield, S.M. and Slater. S. Rectal lymphoma after colectomy for ulcerative colitis.Gut, 1992;33:138-39.11. Dawson, LM.P., Comes, J.S. and Morson, B.C. Primary malignant lymphoid tumors of theintestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br.J.Surg.,1961;49:80-9.12. Renton, P. and Blackshaw., A.J. Colonic lymphoma complicating ulcerative colitis. Br.J. Surg.,1976;63:542-45.

Lymphoma complicating ulcerative colitis

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1204&amp;context=pakistan_fhs_mc_med_gastroenterol

Lymphoma complicating ulcerative colitis

Abstract

Similar works

Full text

Available Versions

eCommons@AKU