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• W4383223625 abstract "eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiNGY0OWEzMjllYTUzZjA3MzNiMjgzYmI0MzQ5Y2I1YSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjkyNTA1NDA5fQ.gUdFhdJK6Pp3tOV7VaIEvzTAcdbjdSCLOCqf_cWpGhYctKZqjq7A1pJYLyCIqPlPgnwFppGnAjTjeBPSuTcv2uaH3xY8zOzWUKCA3alOmXpdODvzL3K5Fc3VDf54b79MtxPULPtPkNBKCcNgX57j_0OHleO-T2YecV0iFmV61_ZdzJeLOy66zupLWiJvS-ZR0hsJNUlo82E8Emn72b0NZBJ6PwcE4mljFn5fGiLW70ZWPEwRcBGsMQ6l7PqoXYprooRiA7Mp4M_RxIJhPlfP7394uF58W3cflsB83sgi5qqqiC1rlLh3lxFObgVOUZxZCuiAOP7HU-WqRPdOABa_Hw(mp4, (26.9 MB) Download video Colonic abnormalities observed in the course of systemic multiple myeloma. A 72-year-old woman who presented with weight loss, arthralgias, thrombocytopenia, and anemia was diagnosed with multiple myeloma, confirmed by serum tests, immunofixation, and a bone marrow biopsy. In addition, because she had abdominal pain and loose stools, a colonoscopy was performed. Examination disclosed multiple ulcerated and umbilicated tumorous lesions throughout the colon, with morphology similar to subepithelial lesions (SELs) with ulcerations (Figure 1, Figure 2, Figure 3). Bite-on-bite biopsy specimens were taken to obtain a submucosal component of the lesion. Biopsy specimens of colonic abnormalities were taken, and histopathology revealed infiltration of large lymphoid cells, expressing CD20, Bcl2, and high mitotic activity (Ki67 ∼60%) (Figure 4, Figure 5, Figure 6). PanCK and S100 staining were negative and ruled out neoplasm with epithelial origin and melanoma. No extracolonic lesions could be found on EGD, CT, or positron emission tomography scans. Infectious diseases, including HIV, were ruled out. A diagnosis of diffuse large B-cell lymphoma (DLBCL) limited to the colon was made based on positive staining for CD20 and Bcl2. The patient was treated for multiple myeloma and DLBCL with bortezomib, cyclophosphamide, thalidomide, and dexamethasone, followed by darbepoetin administration for the anemia. After 6 months of systemic treatment, the patient negated clinical symptoms, and a surveillance colonoscopy showed complete resolution of all lesions (Video 1, available online at www.videogie.org).Figure 2Endoscopic view of colon and lesion.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Endoscopic view of the lesion under narrow-band imaging.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Bcl20; histochemical staining of biopsy samples (Bcl 2 immunohistochemical staining, orig. mag. ×200).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 5CD20; histochemical staining of biopsy samples.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 6Ki67 60%; histochemical staining of biopsy samples.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Although the GI tract is the leading extranodular location for DLBCL,1Wu X.C. Andrews P. Chen V.W. et al.Incidence of extranodal non-Hodgkin lymphomas among Whites, Blacks, and Asians/Pacific Islanders in the United States: anatomic site and histology differences.Cancer Epidemiol. 2009; 33: 337-346Crossref PubMed Scopus (60) Google Scholar the large intestine is rarely invaded (3% of cases). If affected, lesions appear focally, involving selected parts rather than the entire colon.2Myung S.J. Joo K.R. Yang S.K. et al.Clinicopathologic features of ileocolonic malignant lymphoma: analysis according to colonoscopic classification.Gastrointest Endosc. 2003; 57: 343-347Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar Clinical manifestations of colonic DLBCL are nonspecific. Endoscopically, lymphoma appears mainly as fungating and ulcerofungating, rather than ulcerative, infiltrative, ulcerofungating, or another ulcer infiltrative type.1Wu X.C. Andrews P. Chen V.W. et al.Incidence of extranodal non-Hodgkin lymphomas among Whites, Blacks, and Asians/Pacific Islanders in the United States: anatomic site and histology differences.Cancer Epidemiol. 2009; 33: 337-346Crossref PubMed Scopus (60) Google Scholar,2Myung S.J. Joo K.R. Yang S.K. et al.Clinicopathologic features of ileocolonic malignant lymphoma: analysis according to colonoscopic classification.Gastrointest Endosc. 2003; 57: 343-347Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar In our case, lesions were mainly SEL-like with ulcerations on the surface, similar to GI tumors or schwannomas.3Kang J.H. Kim S.H. Kim Y.H. et al.CT features of colorectal schwannomas: differentiation from gastrointestinal stromal tumors.PLoS One. 2016; 11e0166377Crossref Scopus (4) Google Scholar,4Akahoshi K. Oya M. Koga T. et al.Current clinical management of gastrointestinal stromal tumor.World J Gastroenterol. 2018; 24: 2806-2817Crossref PubMed Scopus (148) Google Scholar Also, there was no polyp-like pattern in narrow-band imaging, or other common features. The simultaneous occurrence of DLBCL and multiple myeloma is rare, and hematological neoplasms typically develop secondary to multiple myeloma.3Kang J.H. Kim S.H. Kim Y.H. et al.CT features of colorectal schwannomas: differentiation from gastrointestinal stromal tumors.PLoS One. 2016; 11e0166377Crossref Scopus (4) Google Scholar Mature B-cell neoplasms are the most common among all lymphomas.3Kang J.H. Kim S.H. Kim Y.H. et al.CT features of colorectal schwannomas: differentiation from gastrointestinal stromal tumors.PLoS One. 2016; 11e0166377Crossref Scopus (4) Google Scholar Given this, as well as the poorer prognosis of multiple myeloma with coexisting DLBCL,5Hasskarl J. Ihorst G. De Pasquale D. et al.Association of multiple myeloma with different neoplasms: systematic analysis in consecutive patients with myeloma.Leuk Lymphoma. 2011; 52: 247-259Crossref PubMed Scopus (68) Google Scholar in-depth diagnostics should be provided in the case of GI tract manifestation. The authors did not disclose any financial relationships. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiNGY0OWEzMjllYTUzZjA3MzNiMjgzYmI0MzQ5Y2I1YSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjkyNTA1NDA5fQ.gUdFhdJK6Pp3tOV7VaIEvzTAcdbjdSCLOCqf_cWpGhYctKZqjq7A1pJYLyCIqPlPgnwFppGnAjTjeBPSuTcv2uaH3xY8zOzWUKCA3alOmXpdODvzL3K5Fc3VDf54b79MtxPULPtPkNBKCcNgX57j_0OHleO-T2YecV0iFmV61_ZdzJeLOy66zupLWiJvS-ZR0hsJNUlo82E8Emn72b0NZBJ6PwcE4mljFn5fGiLW70ZWPEwRcBGsMQ6l7PqoXYprooRiA7Mp4M_RxIJhPlfP7394uF58W3cflsB83sgi5qqqiC1rlLh3lxFObgVOUZxZCuiAOP7HU-WqRPdOABa_Hw Download .mp4 (26.9 MB) Help with .mp4 files Video 1Colonic abnormalities observed in the course of systemic multiple myeloma." @default.
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• W4383223625 date "2023-08-01" @default.
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• W4383223625 title "Systemic multiple myeloma and colonic abnormalities" @default.
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