Large bowel lymphoma

Last revised by Mohammad Taghi Niknejad on 8 Oct 2022

Large bowel (colorectal) lymphoma is a very rare tumor, accounting for <0.5% of primary colorectal malignancies, ~1.5% of all lymphomas, and ~15% of gastrointestinal lymphomas. Large bowel lymphoma differs from gastric and small bowel lymphoma in clinical presentation, management, and prognosis. 

Most commonly occurs in patients in their 40s to 60s, with increasing incidence with age. There is a slight male predominance (M:F = 1.5:1) 2

As with other colorectal tumors, primary symptoms are weight loss, pain and, less commonly, per rectal bleeding 2. Large bowel obstruction and perforation are rare. 

Diffuse large B-cell lymphoma is the most common subtype (~65%) of large bowel lymphoma. Less common subtypes include mucosa-associated lymphoid tissue (MALT) lymphoma and mantle cell lymphoma (MCL) 5

The underlying etiology is unknown but an infective/inflammatory pathogenesis is suspected as there is higher incidence in patients with HIV/AIDS, inflammatory bowel disease, and post-transplantation immunosuppression 1

The majority (~70%) of large bowel lymphomas occur in the right colon 2

Compared to colorectal adenocarcinoma, lymphoma affects longer and multiple colonic segments 4, mostly characterized by circumferential wall thickening.  

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Cases and figures

  • Case 1: secondary to Burkitt lymphoma
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  • Case 2: rectal mantle cell lymphoma
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  • Case 3: diffuse large B-cell lymphoma
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  • Case 4: diffuse large B-cell lymphoma of the colon
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  • Case 5: cecal lymphoma
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  • Case 6
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