Patient and observation:
Patient information: A 38-year-old woman presented with
constipation, a feeling of incomplete evacuation and weight loss.
Clinical findings: A fixed mass was identified on digital
rectal examination. No palpable superficial lymph nodes were identified
and chest x-ray was normal.
Diagnostic Assessment: The colonoscopy revealed a
circumferential ulcerated non obstructive mass about 5 cm from the anal
verge extended up to 10 cm (Figure 1). Rectal biopsy concluded in
non-Hodgkin’s diffuse large B-cell lymphoma (DLBCL) CD20(+), CD5(+),
CD3(+), Bcl-2(–), CD56(–), CD117 (–), cyclin D1 (-), and Ki-67 at
80% (Figure 2). Cervical and thoraco-abdomino-pelvic computed
tomography (CT-scan) showed irregular circumferential non-stenosing
parietal thickening of the rectum located at 4 cm from the anal verge
and extended over 9cm. Mesorectal and bilateral hypogastric lymph nodes
were identified, the largest one measured 26 x 20 mm (Figure 3). CEA,
LDH, white blood cell count and the bone marrow biopsy were normal.
According to the Ann Arbor staging classification, tumor was classified
stage IIE.
Therapeutic intervention: The patient received six cycles of
R-CHOP chemotherapy including Rituximab, cyclophosphamide, doxorubicin,
vincristine and prednisolone with good tolerance.
Follow-up and outcomes : Radiological and endoscopic evaluation
concluded in a complete remission confirmed with rectal biopsy. The
patient is monitored each 3 months and is still in complete remission
after 18 months of follow up.