Thuraisingam Amalan, Jaffry Kumail, Papa Brigitte
Surgery, Monash Health, Clayton, AUS.
Surgery, Monash Health, Dandenong, AUS.
Cureus. 2025 Jun 16;17(6):e86150. doi: 10.7759/cureus.86150. eCollection 2025 Jun.
Primary diffuse large B-cell lymphoma (DLBCL) of the colon, particularly involving the caecum, is rare and often poses a diagnostic challenge due to its non-specific presentation and the low incidence of colorectal involvement. Early recognition is crucial, as timely diagnosis and multidisciplinary management can significantly improve patient outcomes. A 29-year-old female presented with a two-week history of intermittent lower abdominal pain, progressive abdominal bloating, weight loss, night sweats, and bilateral ankle swelling over the last four weeks. Initial ultrasonography revealed a large soft tissue mass within the abdomen, initially reported as an ovarian mass; however, further evaluation, including CT imaging and colonoscopy, revealed an ulcerated, partially obstructing caecal mass. Histopathological examination of endoscopic biopsies confirmed DLBCL, non-germinal-centre B-cell subtype. PET imaging revealed multiple large, intensely fluorodeoxyglucose (FDG)-avid lymph nodes below the diaphragm forming a bulky nodal mass, along with a similarly FDG-avid caecal mass, strongly suggesting extra-nodal lymphoma involvement. The patient was subsequently managed with R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone) chemotherapy under the guidance of a multidisciplinary team. Primary colonic DLBCL is rare, accounting for a small fraction of colorectal malignancies. Its non-specific symptoms, including abdominal pain, altered bowel habits, and constitutional complaints, can mimic more common gastrointestinal conditions. This case highlights the importance of maintaining a broad differential diagnosis, especially in younger patients. While imaging modalities, endoscopic assessment, and histopathology are critical for accurate diagnosis, prompt oncologic consultation and chemotherapy remain central to management. A multidisciplinary treatment approach is vital in improving patient prognosis.
原发性结肠弥漫性大B细胞淋巴瘤（DLBCL），尤其是累及盲肠的情况较为罕见，由于其表现不具特异性且结肠受累的发生率较低，常常给诊断带来挑战。早期识别至关重要，因为及时诊断和多学科管理可显著改善患者预后。一名29岁女性，有两周间歇性下腹痛病史，近四周腹部进行性腹胀、体重减轻、盗汗，双侧踝关节肿胀。初始超声检查发现腹内有一巨大软组织肿块，最初报告为卵巢肿块；然而，包括CT成像和结肠镜检查在内的进一步评估显示，盲肠有一溃疡、部分梗阻性肿块。内镜活检的组织病理学检查确诊为DLBCL，非生发中心B细胞亚型。PET成像显示，横膈以下有多个大的、强烈摄取氟脱氧葡萄糖（FDG）的淋巴结，形成一个巨大的淋巴结肿块，同时还有一个同样摄取FDG的盲肠肿块，强烈提示结外淋巴瘤受累。该患者随后在多学科团队的指导下接受了R-CHOP（利妥昔单抗、环磷酰胺、盐酸多柔比星（羟基柔红霉素）、硫酸长春新碱（安可平）和泼尼松）化疗。原发性结肠DLBCL很罕见，占结直肠恶性肿瘤的一小部分。其非特异性症状，包括腹痛、排便习惯改变和全身不适，可类似于更常见的胃肠道疾病。本病例强调了保持广泛鉴别诊断的重要性，尤其是在年轻患者中。虽然影像学检查、内镜评估和组织病理学对于准确诊断至关重要，但及时的肿瘤学咨询和化疗仍然是治疗的核心。多学科治疗方法对于改善患者预后至关重要。
