J Pathol Transl Med.  2019 Sep;53(5):332-336. 10.4132/jptm.2019.07.12.

Diffuse Involvement of Primary Colorectal Lymphoma Simulating Ulcerative Colitis

• Kim JY
• Chang SH
• Kim HS
• Joo M

• KMID: 2459582
• DOI: http://doi.org/10.4132/jptm.2019.07.12

Abstract

Diffuse involvement of colorectal lymphoma masquerading as colitis is a very rare presentation of primary colorectal lymphoma. Detecting occult lymphoma is difficult in the setting of diffuse colonic involvement with no definite mass and inflammatory mucosal changes. We encountered a case of diffuse-type primary colorectal lymphoma simulating ulcerative colitis in a previously healthy 31-year-old woman. Despite multiple mucosal biopsies, the biopsy diagnosis was not made due to unawareness of atypical lymphocytes admixed with dense lymphoplasmacytic infiltration. The present case emphasizes the importance of being aware of this rare presentation of primary colorectal lymphoma in order to avoid misdiagnosis.

Keyword

Colorectal lymphoma; Primary; Diffuse type; Colitis

MeSH Terms

Adult
Biopsy
Colitis
Colitis, Ulcerative*
Colon
Diagnosis
Diagnostic Errors
Female
Humans
Lymphocytes
Lymphoma*
Ulcer*

Figure

• 

  Fig. 1. (A) Colonoscopy reveals diffuse hyperemic inflamed mucosa with total loss of normal vascularity and surface ulceration from the rectum to the cecum. (B, C) Representative microphotographs of diffuse lymphoma involvement on the biopsy specimens. (B) The mucosa and submucosa are diffusely involved by densely packed lymphocytes with the background remnants of colonic crypts. Monotonous large-sized lymphocytes have vesicular chromatin and often membrane-bound nucleoli, resembling centroblasts (C). (D–F) Retrospective examination of initial colonoscopic biopsy. (D) The biopsied colonic mucosa displays crypt architectural distortion and dense inflammatory cell infiltration, resembling chronic colitis. Atypical lymphoid cells are aggregated in the bottom right corner (below the yellow dotted line), which show not only strong expression on CD20 immunostaining (E) but also high Ki-67 labeling index (F).

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