Synchronous rectal adenocarcinoma and splenic marginal zone lymphoma.

T Srikumar,S Hoffe,B Centeno,J Strosberg,M Markow,D Shibata,H Fernandez,J Tao

doi:10.3747/co.23.2711

Abstract

Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl). A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made. The patient's management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil-leucovorin-oxaliplatin) chemotherapy and has remained disease-free for 7 years. To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation.

Highlights

Colorectal carcinoma is the second leading cause of cancerrelated death in the United States[1,2,3,4]
We describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation
The patient received neoadjuvant 5fu and rituximab plus pelvic radiotherapy; surgical resection of spleen and rectum followed; and treatment concluded with colorectal cancer–targeted systemic adjuvant chemotherapy

Summary

INTRODUCTION

Colorectal carcinoma is the second leading cause of cancerrelated death in the United States[1,2,3,4]. The patient received neoadjuvant 5fu and rituximab plus pelvic radiotherapy; surgical resection of spleen and rectum followed; and treatment concluded with colorectal cancer–targeted systemic adjuvant chemotherapy. At the time of operation, her spleen was slightly enlarged, with lymphadenopathy in the splenic hilum and intimate involvement of the distal tail of the pancreas Her rectal cancer was noted to be just above the sphincter complex, but a plane could not be developed between the tumour and the posterior vaginal wall. The final pathology report revealed that the lymph nodes of the splenic hilum harboured some residual marginal zone lymphoma [Figure 2(A)]. Those cells were positive for CD79a, Bcl[2], and CD20; neoplastic cells were negative for CD3 and CD5. The patient has been disease-free, without signs of progression for 7 years

DISCUSSION

Findings

SUMMARY