Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Department of Gastroenterological, General, Breast and Thyroid Surgery (First Department of Surgery), Yamagata University Faculty of Medicine, Yamagata, Japan.
Diagn Pathol. 2020 Apr 7;15(1):34. doi: 10.1186/s13000-020-00954-8.
Ulcerative colitis (UC) is one of the major types of inflammatory bowel diseases and is associated with a significantly increased risk of not only lymphoproliferative disorders but also lymphomas, of which most cases are related to the long-term usage of immunosuppressants. Here, we demonstrate a very rare case of other iatrogenic immunodeficiency-associated colonic diffuse large B-cell lymphoma (Oii-DLBCL) complicating UC and rectal perforation. In addition, we reviewed the clinicopathological features of previous cases of DLBCL related to UC.
A 68-year-old man was diagnosed with left-sided UC 26 months prior. Although he was followed by immunosuppressive therapy with azathioprine and infliximab, an emergency total proctocolectomy was performed due to rectal perforation. The resected specimen exhibited irregular wall thickening and elevated multinodular lesions extending from the mid-transverse colon to the rectum, measuring up to 52 cm in length. Histologically, the lesion was diagnosed as Oii-DLBCL and crypt abscess surrounded by mixed inflammatory cell was remained.
Oii-DLBCL complicating UC with rectal perforation is extremely rare. Macro- and microscopic findings are important for early diagnosis of the lesion.
溃疡性结肠炎（UC）是炎症性肠病的主要类型之一，不仅与淋巴增生性疾病而且与淋巴瘤的风险显著增加有关，其中大多数病例与长期使用免疫抑制剂有关。在这里，我们展示了一例非常罕见的与 UC 和直肠穿孔相关的医源性免疫缺陷相关的结肠弥漫性大 B 细胞淋巴瘤（Oii-DLBCL）。此外，我们复习了以前与 UC 相关的 DLBCL 的临床病理特征。
一名 68 岁男性在 26 个月前被诊断为左侧 UC。尽管他接受了硫唑嘌呤和英夫利昔单抗的免疫抑制治疗，但由于直肠穿孔而行紧急全结肠直肠切除术。切除标本显示不规则的壁增厚和升高的多结节病变从横结肠中段延伸至直肠，长度达 52cm。组织学上，该病变被诊断为 Oii-DLBCL，伴有混合炎症细胞围绕的隐窝脓肿。
UC 合并直肠穿孔的 Oii-DLBCL 极为罕见。宏观和微观表现对早期诊断病变很重要。
