title: Diffuse large B-cell lymphoma of the colon with synchronous liver metastasis: a rare case report mimicking metastatic colorectal adenocarcinoma.
abstract: BACKGROUND
  Primary colorectal lymphoma represents a rare minority among the colonic neoplasms. Early diagnosis is often difficult because of unspecific symptoms, with subsequent delays in diagnosis and management. We describe a rare case of colonic lymphoma presenting with synchronous liver metastasis.
  
  
  METHODS
  A 70-year-old male with a 6-mo history of vague abdominal pain, constipation and melena was referred to our hospital. Computed tomography scan of abdomen revealed the presence of a mass along the proximal ascending colon. Colonoscopy biopsy showed external compression of the cecum with two ulcerations of mucosa, but it was not consistent for a definitive diagnosis. Because the difficulties in the preoperative pathological diagnosis, the high risk of bowel obstruction and the correlated hemorrhagic risk, the patient underwent a right hemicolectomy associated with locoregional lymphadenectomy and liver resection.The surgically resected right colon and liver tumors were all immunohistochemically diagnosed as diffuse large B-cell lymphomas (DLBCL). The patient refused any other antineoplastic treatment; he is alive and free of disease at 3 years after initial diagnosis.
  
  
  CONCLUSIONS
  Primary colonic lymphomas represent a rare minority among the colonic neoplasms. Their correct pre-operative identification is crucial for the design of treatment. This case highlights the difficulty in diagnosing of primary colonic lymphoma. To our knowledge, this is the first report of a colonic lymphoma presenting with a colonic mass and a synchronous liver metastasis.
authors.affiliation: Unit of General and Laparoscopic Surgery, "G, d'Annunzio" University, Via dei Vestini 31, 66100 Chieti, Italy. domenicorisio@virgilio.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Risio
authors.forename: Rossana
authors.initials: R
authors.lastname: Percario
authors.forename: Margherita
authors.initials: M
authors.lastname: Legnini
authors.forename: Francesco
authors.initials: F
authors.lastname: Caldaralo
authors.forename: Domenico
authors.initials: D
authors.lastname: Angelucci
authors.forename: Camilla
authors.initials: C
authors.lastname: Marinelli
authors.forename: Alberto
authors.initials: A
authors.lastname: D'Aulerio
authors.forename: Roberto
authors.initials: R
authors.lastname: Cotellese
authors.forename: Luca
authors.initials: L
authors.lastname: Napolitano
authors.forename: Paolo
authors.initials: P
authors.lastname: Innocenti
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary*; D000368:Aged; D001706:Biopsy; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D003937:Diagnosis, Differential; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary*; D016393:Lymphoma, B-Cell / Q000175:diagnosis*; D008297:Male; D009378:Neoplasms, Multiple Primary; D014057:Tomography, X-Ray Computed