Discussion:
The most common histologic subtype of NHL affecting the GI tract and
colon is DLBCL. PRL usually presents with signs and symptoms suggestive
of primary rectal carcinoma: weight loss, abdominal pain and lower
gastro-intestinal bleeding
[4].
Whatever the presentation, endoscopy with biopsy are the most valuable
diagnostic tests. The majority of colorectal lymphomas are localised in
the cecum or ascending colon
[5].
As reported in the literature, colonoscopy showed in our case a budding
rectal mass, and biopsy confirmed the diagnosis of DLBCL.
Immunohistochemistry usually used to confirm diagnosis is CD20, CD79a,
and
CD10 [6].
CT scan is usually used to study tumor extension. Concentric rectal wall
thickening with or without a regional lymph node involvement are
frequently reported. Positron emission tomography (PET) is currently
indicated in the diagnosis and disease follow-up
[7].
The Ann Arbor staging system modified by Musshoff is widely used in
tumor classification
[8].
Given the rarity of the rectal localization, there is no standard
treatment protocol. Chemotherapy remains the the main therapeutic
modality
[9].R-CHOP
protocol including Rituximab, cyclophosphamide, doxorubicin, vincristine
and prednisone remains the most used protocol
[10].
Several studies reveal a trend toward improved survival when surgery is
used in combination with chemo- or radiotherapy
[11].
In our case, we have treated patient with chemotherapy with a complete
response. Jeong and al noted a significant difference in survival
between patients with stages I-II and stage IV disease
[5].