Primary Rectal Lymphoma Responding to Chemotherapy as Sole Treatment: A Case Report

Abstract

Primary rectal lymphoma is a rare disease. Unlike other primary gastrointestinal lymphomas (stomach, small intestine, and colon) the behavior of this kind of lymphoma, as well as its management, is not fully understood. Most of the literature available, despite being limited, has recommended different modalities in treatment and has varying outcomes. Hence there is still no available consensus guidelines. We present a case of a 52-year-old woman with constipation and hematochezia. Physical examination was essentially normal except for a palpable rectal mass. There was no lymphadenopathy appreciated. The initial impression was a primary rectal adenocarcinoma but work-up done were unremarkable including CEA. Histopathology with immunostaining revealed a diagnosis of diffuse large B-cell lymphoma (DLBCL) of the rectum, Lugano stage IIE. Despite unofficial recommendations of surgical management for a resectable, low stage lesion, the patient underwent chemotherapy only (R-CHOPS) for 6 cycles resulting to both clinical and endoscopic response. Despite our present success with our patient, we cannot recommend based on a single case. Our case can be included in the very few cases of primary rectal lymphoma that can be accumulated altogether and subject to a larger scientific study that will lead to a better understanding of this rare disease.