title: Synchronous rectal adenocarcinoma and splenic marginal zone lymphoma.
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.
authors.affiliation: Morsani College of Medicine, University of South Florida, Tampa, FL, U.S.A.;; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.;
authors.forename: T
authors.initials: T
authors.lastname: Srikumar
authors.affiliation: Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, U.S.A.;; Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.;
authors.forename: M
authors.initials: M
authors.lastname: Markow
authors.affiliation: Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.;
authors.forename: B
authors.initials: B
authors.lastname: Centeno
authors.affiliation: Department of Radiation Oncology and Therapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.;
authors.forename: S
authors.initials: S
authors.lastname: Hoffe
authors.affiliation: Department of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.;
authors.forename: J
authors.initials: J
authors.lastname: Tao
authors.affiliation: Department of Blood and Marrow Transplant, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.;
authors.forename: H
authors.initials: H
authors.lastname: Fernandez
authors.affiliation: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A.;
authors.forename: J
authors.initials: J
authors.lastname: Strosberg
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, U.S.A.
authors.forename: D
authors.initials: D
authors.lastname: Shibata
keywords: 5-fluorouracil; Rectal cancer; neoadjuvant chemoradiation; non-Hodgkin lymphoma; rituximab