Primary colonic Lymphoma. Can endoscopic resection be a definitive therapeutic option?

Introduction Primary colonic lymphoma (PCL) is a rare variety of non-Hodgkin lymphomas (NHL) and represents 0.2-1.2% of all primary colon neoplasias. We present the case of a 61-year-old male who presented, during a colonoscopy performed within the colorectal cancer screening program, a giant non-granular lateral growth lesion Paris 0-IIa+IIb, occupying at least 3 haustras in anteroposterior diameter and 60% of the circumference. A piece-meal underwater endoscopic mucosal resection was performed with complete resection of the lesion, enlarging healthy margins. No remains of the lesion or damage to the muscle layer were seen. The edges of the scar were treated with closed hot forceps/soft coag 80W. There were no immediate or delayed complications. Histologically, it was a low-grade B-cell lymphoma of the marginal zone. The extension study performed with PET CT, bone marrow biopsy and gastroscopy did not show extracolonic involvement. The control colonoscopy one year later showed no signs of endoscopic recurrence and the follow-up by Hematology ruled out extracolonic involvement.

Comment The endoscopic appearance of PCL lacks specificity. There is no uniformly agreed treatment for PCL and endoscopic treatment is anecdotal in the available reports. Our case was treated with a piece-meal endoscopic resection without presenting endoscopic or distant recurrence one year later. Therefore, in very localized and well-defined lesions it could be a therapeutic option to consider.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025