malt lymphoma | Rectum MALT lymphoma: about a case treated by IrradiationMALT lymphoma of the rectum: a case report treated by radiotherapy

Rectum MALT lymphoma: about a case treated by IrradiationMALT lymphoma of the rectum: a case report treated by radiotherapy



Resume
The lymphoid tissue-type lymphoma associated with the mucosa (malt) is a distinct anatomoclinique entity. This lymphoma has been described in different anatomical sites tells Quebec stomach, skin, thyroidinum, salivary glands, breasts and bronchopulmonary tree. However, Rectocolique localization is extremely rare. To our knowledge, a dozen cases have been described in the literature. We report the case of radiation-treated rectal malt type lymphoma in a woman aged 46 years. The patient had rectorragies. The colonoscopy showed a large fold, pseudonodulaire and rankled of the rectum. Histological and immunohistochemical examination showed a typical appearance of a malt lymphoma. The high digestive fibroscopy with biopsy showed chronic gastritis to Helicobacter pylori without lymphomateuse infiltration. The extension balance, including a scanning thoraco-abdomonopelvienne and a ostéomédullaire biopsy was normal. It was issued a tritherapy directed against the H. Seven-day pylori, associating Omeprazole, amoxicillin and metronidazole. Eradication was confirmed by high digestive endoscopy with biopsy. However, control colonoscopy after four months of the end of treatment showed the same endoscopic appearance with the persistence biopsy of the lymphomateux infiltrate. The disease was considered non-responsive to eradication treatment and radiotherapy was proposed. The latter issued a dose of 34 GY in four weeks. The complete endoscopic and histological remission was confirmed two months after the end of the treatment. Regular endoscopic surveillance did not show relapse with a 12-month retreat.

Abstract
The lymphoma of the lymphoid tissue associated with the mucous membranes (malt) is a distinct pathological clinical entity that develops in various anatomical places such as the stomach, the salivary gland, the thyroid, the lung, the skin and the breast. However, colorectal involvement is extremely rare. To our knowledge, only ten cases of primary rectal malt lymphoma have been reported in the literature. We report a 46-year-old woman with rectal malt lymphoma, which regressed after radiation therapy. The patient had rectal bleeding. The colonoscopy showed a pseudonodular and ulcerated large crease in the rectum. Microscopic and immunohistologic studies of the biopsy sample showed typical characteristics of low-grade malt lymphoma. Upper endoscopy showed chronic gastritis with lymphoid follicles, but without any infiltration of lymphoma cells. Helicobacter pylori infection was confirmed by histology. No extra-intestinal involvement was found on the staging assessment, which included computed tomography (CT) of the abdomen, chest, pelvis, and bone marrow biopsy. We tried to eradicate H. pylori with a 7-day course of omeprazole, Amoxycillin, and metronidazole. The eradication has been successfully proven by endoscopy. A colonoscopy repeated 4 months after the treatment was completed showed that the rectal tumour had not regressed. The biopsy samples confirmed the persistent infiltration of the lymphoma cells. The patient has been considered a non-responder to eradication therapy and has been indicated for radiation treatment. It underwent a total of 34 GY. A complete regression was confirmed by colonoscopy and histological examination at 2 months after completion of treatment. It was followed in close collaboration with colonoscopy, but no relapse of these lesions was detected after 12 months.