1650 A Case of Rectal Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Presenting as Telangiectasia: A Case Report

Abstract

INTRODUCTION: The World Health Organization classification of lymphoid neoplasms consists of several marginal zone lymphoma subtypes, the most common of which is extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT lymphoma). Extranodal marginal zone lymphomas can stem from a number of epithelial tissues, including the lungs, thyroid, skin, and GI tract. Of all tissues with possible extranodal lymphoma involvement, the GI tract is the most common. However of these GI sites, colorectal lymphoma is rare, accounting for approximately 3 percent of the GI lymphomas and only 0.3 percent of all large intestinal malignancies. Symptoms including abdominal pain, occult bleeding, bowel obstruction and diarrhea are possible findings in patients with colorectal lymphoma. Findings on colonoscopy can include mucosal nodularity, ulceration and or even a mass. CASE DESCRIPTION/METHODS: This is a 68-year-old male with a past medical history of hemorrhoids who initially presented to clinic with complaints of hematochezia for 15 days. Patient denied any associated symptoms including fever, chills, nausea or vomiting. Physical exam revealed bright red blood per rectum. A colonoscopy was scheduled, during which the patient was found to have inflamed proximal rectal mucosa of which a biopsy was taken and sent for pathology report. Biopsy revealed diffuse infiltration of the mucosa by small lymphoid cells focally involving the epithelium which were positive for b-cell immunoperoxidase markers. These findings were consistent with malignant lymphoma (B-cell phenotype) of the extranodal marginal zone mucosa associated type. Following postoperative recovery, the patient opted for conservative management with repeat colonoscopy scheduled 6 months later. DISCUSSION: Extranodal marginal zone lymphomas can arise from numerous tissues. While these neoplasms often remain localized to the tissue from which the originate, diagnosis is critical because not only does recurrence frequently occur locally, but they also have the potential to transform into aggressive B cell lymphoma variants with eventual systemic spread. Although MALT lymphoma of the GI tract can present in different forms such as nodularity, ulceration or mass, this is a case of MALToma presenting in the form of telangiectasia. In this patient, correctly taking a biopsy of a telangiectatic region of mucosa resulted in diagnosis of a rare yet treatable pathology.