J Korean Surg Soc.  2012 Jul;83(1):60-64. 10.4174/jkss.2012.83.1.60.

Synchronous T-cell lymphoma in patient with colon cancer: a case report

• Lee DY
• Hong SW
• Chang YG
• Lee WY
• Lee B
• Kang YK

• KMID: 2212281
• DOI: http://doi.org/10.4174/jkss.2012.83.1.60

Abstract

Colorectal cancer is the third most common malignancy in Korea. In contrast, pericolic or mesenteric lymphoma is relatively rare. We experienced an extremely rare case of synchronous primary colon cancer in the ascending colon with T-cell lymphoma in the pericolic lymph node. A 79-year-old woman presented with complaints of epigastric and right lower abdominal pain combined with anorexia and nausea. Colonoscopic evaluation and biopsy were performed, and the diagnosis was cecal adenocarcinoma. She underwent right hemicolectomy with lymph node dissection. The pathology report revealed adenocarcinoma in cecum with metastasis to 1 regional lymph node out of 37 lymph nodes. In addition, there was malignant angioimmunoblastic T-cell lymphoma in 1 pericolic lymph node. There was no evidence of lymphoma in ileum, cecum and ascending colon, so the possibility of early phase of lymphoma was suggested.

Keyword

T-cell lymphoma; Colon cancer; Multiple primary

MeSH Terms

Abdominal Pain
Adenocarcinoma
Aged
Anorexia
Biopsy
Cecum
Colon
Colon, Ascending
Colonic Neoplasms
Colorectal Neoplasms
Female
Humans
Ileum
Korea
Lymph Node Excision
Lymph Nodes
Lymphoma
Lymphoma, T-Cell
Nausea
Neoplasm Metastasis
T-Lymphocytes

Figure

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  Fig. 1 (A, B) Contrast enhanced computed tomography scan shows irregular heterogeneous wall thickening in cecum and terminal ileum (arrowheads). There were several enhancing pericolic lymph nodes, suggesting metastasis (arrows).

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  Fig. 2 (A, B) Colonoscopic finding revealed hyperemic lobulated ulcerofungating mass lesion in cecum, which was nearly obstructing cecal lumen. The mass was extened into ileum, but the origin was uncertain.

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  Fig. 3 (A) Grossly, specimen was revealed as ulceroinfiltrative tumorous lesion in cecum, measuring about 7 × 5 cm. (B) Cut surface showed tumor infiltration to the pericolic and mesenteric adipose tissue.

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  Fig. 4 (A) Non-neoplastic pericolic lymph node with preserved architecture (H&E, ×10). (B) Lymph node with lymphoma involvement. There is subtotal architectural effacement with perinodal infiltration (arrow) (H&E, ×10). (C) Presence of reactive cells including follicular dendritic cells (arrow) and eosinophils (arrowhead) are noted (H&E, ×400). (D) The lymph node was replaced by atypical polymorphous lymphoid cells (H&E, ×400). (E) Atypical lymphoid cells were CD3 (T lymphocytic marker) positive (immunohistocemical staining, ×400). (F) In situ hybridization for Epstein-Barr virus was nuclear positive in reactive B-immunoblasts (arrow) (×400).

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