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Case Report

Synchronous Rectal Adenocarcinoma and Splenic Marginal Zone Lymphoma

1
Morsani College of Medicine, University of South Florida, Tampa, FL, USA
2
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
3
Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
4
Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
5
‖Department of Radiation Oncology and Therapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
6
Department of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
7
Department of Blood and Marrow Transplant, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
8
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2016, 23(1), 70-74; https://doi.org/10.3747/co.23.2711
Submission received: 9 November 2015 / Revised: 7 December 2015 / Accepted: 5 January 2016 / Published: 1 February 2016

Abstract

Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl). A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made. The patient’s management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil–leucovorin–oxaliplatin) chemotherapy and has remained disease-free for 7 years. To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation.
Keywords: rectal cancer; non-Hodgkin lymphoma; rituximab; 5-fluorouracil; neoadjuvant chemoradiation rectal cancer; non-Hodgkin lymphoma; rituximab; 5-fluorouracil; neoadjuvant chemoradiation

Share and Cite

MDPI and ACS Style

Srikumar, T.; Markow, M.; Centeno, B.; Hoffe, S.; Tao, J.; Fernandez, H.; Strosberg, J.; Shibata, D. Synchronous Rectal Adenocarcinoma and Splenic Marginal Zone Lymphoma. Curr. Oncol. 2016, 23, 70-74. https://doi.org/10.3747/co.23.2711

AMA Style

Srikumar T, Markow M, Centeno B, Hoffe S, Tao J, Fernandez H, Strosberg J, Shibata D. Synchronous Rectal Adenocarcinoma and Splenic Marginal Zone Lymphoma. Current Oncology. 2016; 23(1):70-74. https://doi.org/10.3747/co.23.2711

Chicago/Turabian Style

Srikumar, T., M. Markow, B. Centeno, S. Hoffe, J. Tao, H. Fernandez, J. Strosberg, and D. Shibata. 2016. "Synchronous Rectal Adenocarcinoma and Splenic Marginal Zone Lymphoma" Current Oncology 23, no. 1: 70-74. https://doi.org/10.3747/co.23.2711

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