Cooper Digestive Health Institute Camden, NJ, United States
Nikhita Dharbhamulla, MD, Cynthia McCleery, MD Cooper Digestive Health Institute, Camden, NJ
Introduction: B-cell lymphoma most commonly affects the gastrointestinal tract outside of the lymph nodes. However, it rarely affects the colon as the primary source and accounts for less than 1% of all colorectal malignancies. Patients tend to present with abdominal pain and weight loss as well as hematochezia. Radiographic findings include polypoid mass, circumferential or cavitary lesion, or diffuse ulcerative or nodular lesions. We present a case of primary colonic lymphoma that mimicked the symptoms and radiographic findings of ischemic colitis.
Case Description/Methods: A 75 year-old male with medical history of atrial fibrillation taking rivaroxaban, coronary artery disease status post stent placement, and surgical history of transcatheter aortic valve replacement presented to the hospital after experiencing abdominal cramping associated with fecal urgency, followed by hematochezia. He denied any recent weight loss and abdominal exam was benign. Computed tomography (CT) scan showed findings suspicious for pneumatosis at the hepatic flexure as well as portal venous gas, concerning for ischemic colitis. Lactic acid levels were normal; therefore CT angiography was done that showed a focal mass at the hepatic flexure without any luminal narrowing. The previous pneumatosis and portal venous gas were not identified. Colonoscopy showed a partially obstructing mass at the hepatic flexure and biopsies revealed diffuse large B-cell lymphoma. The patient subsequently underwent chemotherapy for treatment.
Discussion: Primary lymphoma of the colon is a rare tumor that normally presents with abdominal pain and weight loss, and radiography tends to show a colonic mass or nodular lesions. This patient presented with similar symptoms, however initial imaging showed pneumatosis and portal venous gas that was concerning for ischemic colitis, which is not a common manifestation of primary colonic lymphoma. One case report described a patient who was found to have a necrotic colonic ulcer on colonoscopy that resembled ischemia but biopsies revealed lymphoma. Our patient is the only reported case of colonic lymphoma who had radiographic findings concerning for ischemic colitis, suggesting that malignancy should be part of the differential diagnosis for patients who may have signs and symptoms suggestive of ischemic colitis.
Figure: CT scan images showing colonic pneumatosis (triangle, picture A) and portal venous gas (arrows, picture B). CTA image showing mass at the hepatic flexure (circle, picture C). Colonoscopy image of partially obstructing circumferential mass at the hepatic flexure (picture D).
Disclosures: Nikhita Dharbhamulla indicated no relevant financial relationships. Cynthia McCleery indicated no relevant financial relationships.
Nikhita Dharbhamulla, MD, Cynthia McCleery, MD. P1215 - Colonic Lymphoma Disguised as Ischemia on Radiography, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.