Intestinal lymphoma presenting as intermittent bloody diarrhea and abdominal pain

Document Type : Case Reports and Brief Reports


1 Gastroenterologist, Research Center for Infectious Diseases of Digestive System, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Fellowship of Gastroenterology, GI ward, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


Background: Primary lymphoma of the colon is a rare tumor of the GI tract that comprises only 0.2-1.2% of all colonic malignancies and most commonly involve the cecum followed by the right colon and sigmoid. They can mimic features of ulcerative colitis and in this article we reporting a colonic lymphoma, which misdiagnosed as a refractory IBD.
Case Report: This is a middle- aged man presenting with abdominal pain and bloody diarrhea, which is diagnosed as ulcerative colitis, but due to the refractory symptoms and non-responsiveness, he has undergone further evaluation, which revealed the primary diffuse large B -cell lymphoma of the colon as the main culprit of patients’ symptoms and referred for systemic chemotherapy.
Conclusion: Colonic lymphomas can be presented as a mucosal type and characterized by small superficial erosive and hyperemic changes within a mucosal layer that can mimic the features of ulcerative colitis, so in any refractory IBD, their possibility should keep in mind.


Ali Akbar Shayesteh (PubMed)(Google Scholar)
Pezhman Alavinejad (PubMed)(Google Scholar)
1. Ducreux M, Boutron MC, Piard F, et al. A 15-year series of gastro-intestinal non-Hodgkin's lymphomas: A population-based study. Br J Cancer. 1998; 77:511-14.
2. Isaacson PG. Gastrointestinal lymphomas of T- and B-cell types. Mod Pathol. 1999; 12:151-8.
3. Jaffe ES, Harris NL, Stein H, Vardiman JW, ed. Pathology and ge-netics of tumours of haematopoietic and lymphoid tissues, Lyon: IARC Press; 2001.
4. Koch P, del Valle F, Berdel WE, et al: Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol. 2001; 19:3861-73.
5. Tauro LF, Furtado HW, Aithala PS, D'Souza CS, George C, Vish-numoorthy SH. Primary lymphoma of the colon. Saudi J Gastroen-terol. 2009; 15(4):279.
6. Gonzalez QH, Heslin MJ, vila-Cervantes A, et al. Primary colonic lymphoma. Am Surg. 2008; 74:214-16.
7. Dionigi G, Annoni M, Rovera F, et al: Primary colorectal lympho-mas: Review of the literature. Surg Oncol. 2007; 16(Suppl 1): S169-71.
8. Musallam KM, Hatoum HA, Barada K, Taher AT, Salem ME, Malek EM, Shamseddine AI. Primary colorectal lymphoma. Med Oncol. 2010;27(2):249-54.
9. Bairey O, Ruchlemer R, Shpilberg O. Non-Hodgkin's lymphomas of the colon. Isr Med Assoc J. 2006; 8:832–5.
10. Zinzani PL, Magagnoli M, Pagliani G, Bendandi M, Gherlinzoni F, Merla E, et al. Primary intestinal lymphoma: Clinical and thera-peutic features of 32 patients. Haematologica. 1997; 82:305–8.
11. Zighelboim J, Larson MV. Primary colonic lymphoma: Clinical presentation, histological features, and outcome with combina-tion chemotherapy. J Clin Gastroenterol. 1994; 18:291–7.
12. Chiang JM, Lin YS. Tumor spectum of adult intussusception. J Surg Oncol. 2008; 98:444–7.
13. Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: A retro-spective review. Dis Colon Rectum. 2006; 49:1546–51.
14. Greenstein AJ, Mullin GE, Strauchen JA, Heimann T, Janowitz HD, Aufses AH, Sachar DB. Lymphoma in inflammatory bowel disease. Cancer. 1992; 69(5):1119-23.
15. Wang MH, Wong JM, Lien HC, Lin CW, Wang CY. Colonoscopic manifestations of primary colorectal lymphoma. Endoscopy. 2001; 33(7):605-9.
16. Tauro LF, Furtado HW, Aithala PS, D'Souza CS, George C, Vish-numoorthy SH. Primary lymphoma of the colon. Saudi J Gastroen-terol. 2009; 15(4):279.
17. Tondini C, Giardini R, Bozzetti F, Valagussa P, Santoro A, Bertulli R, et al. Combined modality treatment for primary gastrointesti-nal non- Hodgkin's lymphoma: The Milan cancer Institute experi-ence. Ann Oncol. 1993; 4:831–7.
18. Stanojevic GZ, Nestorovic MD, Brankovic BR, Stojanovic MP, Jo-vanovic MM, Radojkovic MD. Primary colorectal lymphoma: An overview. World J Gastrointest Surg. 2011; 15;3(1):14.