Non-Hodgkin's lymphomas of the colon.
BACKGROUND
Non-Hodgkin's lymphoma of the colon is a rare and consequently poorly studied extranodal lymphoma. Most of the previous publications used old pathologic classifications and old diagnostic and treatment approaches.


OBJECTIVE
To examine the clinical presentation, pathologic classification, treatment and outcome of patients with NHL of the colon.


METHODS
A retrospective study was performed of all patients with NHL and involvement of the colon in two medical centers. The patient group consisted of 17 patients over a 13 year period.


RESULTS
Fourteen patients had primary involvement and 3 secondary. The ileocecal region and cecum were the most frequent sites of involvement, occurring in 76% of patients. Most patients had bulky disease: three had a diameter >5 cm and eight a diameter >10 cm. Aggressive histology was found in 12 patients: diffuse large B cell lymphoma in 11 and peripheral T cell lymphoma in 1. Three patients had mantle cell lymphoma and two had indolent lymphomas: mucosa-associated lymphoid tissue (n=l) and small lymphocytic (n=l). Eleven patients underwent hemicolectomy: right sided in 9 and left sided in 2, and 5 DLBCL patients required emergency surgery for intestinal perforation. The median overall survival was 44 months (range 1-147). Disease stage influenced prognosis; six of seven patients with limited-stage DLBCL who received aggressive chemotherapy achieved complete remission and enjoyed prolonged survival, whereas patients with aggressive disseminated disease had resistant disease and poor survival (median 8 months).


CONCLUSIONS
Most colonic lymphomas are aggressive B cell lymphomas. Diagnosis is often delayed. Early diagnosis may prevent perforation. Those with limited-stage disease when treated with aggressive chemotherapy may enjoy prolonged survival. The role of elective hemicolectomy to prevent perforation should be examined in prospective trials.
Bairey
Osnat
O
Institute of Hematology, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. obairey@post.tau.ac.il
Ruchlemer
Rosa
R
Shpilberg
Ofer
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome