A Rare Case of Isolated Superior Mesenteric Vein Thrombosis in an Elderly Woman With Late-Onset Anti-Phospholipid Syndrome (original) (raw)

American Journal of Gastroenterology, 2015

Abstract

a 16x10x13 cm heterogeneous mass in ascending colon and multiple liver masses consistent with metastases (Figure 1). Colonoscopy showed a necrotic friable mass in ascending colon nearly obstructing the lumen (Figure 2). Pathology revealed diff use large B cell lymphoma and immunohistochemical stains confi rmed a pattern favorable of a primary colonic B-cell lymphoma with positive CD20, PAX5, CD10 and BCL6 (Figure 3). Ki 67 was expressed as well in 85 to 95 % of the specimen. Biochemical profi le showed an elevated LDH, while CEA level was within normal limits. Flow cytometry blood test was negative and bone marrow biopsy ruled out any involvement. Th e patient refused surgery and was started on chemotherapy tailored to his lymphoma with favorable response on a PET scan done 6 months later. Primary malignant lymphoma of the colon remains a rare clinical entity specifi cally in immunocompetent individuals, accounting for a small proportion of both colorectal malignancies and GI lymphomas. Commonly it is a disease reported in association with disorders of altered immune status, infl ammatory bowel diseases and celiac disease. Historically, aggressive B-cell lymphomas have been the most common GI lymphomas reported in the literature. Most patients present with nonspecifi c symptoms which oft en lead to delays in diagnosis and advanced stage at presentation, as demonstrated in our patient who presented with metastatic disease to the liver. Treatment usually involves chemotherapy, radiation, surgery or a combination of these, in contrast to colonic adecarcinoma where surgery is the mainstay of therapy. In aggressive lymphomas, resection serves to control local disease to prevent obstruction and perforation, however the defi nitive management remains to be CHOP or other polychemotherapies. Increased awareness of this disease is of utmost importance to avoid delays in diagnosis and tailor further management accordingly, in order to prevent complications.

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