Baylor University Medical Center Proceedings July 2017 - 336

B-lymphoblastic lymphoma of the rectum
Puthillathu Unnikrishnan, MD, Geetha Narayanan, MD, Bhavya S. Kumar, MD, and Nandini Devi, MD

Lymphoblastic lymphoma is a neoplasm of immature cells committed to
the B-cell or T-cell lineage. B-lymphoblastic lymphoma usually involves
lymph nodes and extranodal sites, such as the skin, bone, and soft
tissue. The rectum is a very rare site of involvement in B-lymphoblastic
lymphoma. We describe a 26-year-old man who presented with bleeding
per rectum and fecal incontinence. Endoscopy showed a large nodular
friable lesion narrowing the entire rectal lumen. Biopsy was diagnostic
of B-lymphoblastic lymphoma. He was started on chemotherapy with
the Berlin-Frankfurt-Münster protocol and achieved complete remission
after induction chemotherapy. This is the first report of B-lymphoblastic
lymphoma presenting as a rectal lesion in the world literature.

ymphoblastic lymphomas/leukemias are neoplasms of
precursor T cells and B cells. Lymphoblastic lymphoma
(LBL) is a disease predominantly involving lymph nodes
with less than 20% involvement in the bone marrow, while
lymphoblastic leukemia is predominantly a bone marrow and
circulating blood disease with little nodal involvement. LBL may
be either T or B cell in origin. B-lymphoblastic lymphoma (BLBL) comprises only 10% to 15% of LBLs. It usually involves
lymph nodes and extranodal sites, such as the skin, bone, and soft
tissue (1). The rectum is a very rare site of involvement of B-LBL.
We report a case of B-LBL involving the rectum in a 26-year-old
man. The present case, to the best of our knowledge, is the ﬁrst
reported case of B-LBL involving the rectum.
CASE PRESENTATION
A 26-year-old man presented with constipation, bleeding
per rectum, and signiﬁcant loss of weight of 10-month duration along with recent-onset perianal pain and fecal incontinence. His Eastern Cooperative Oncology Group performance
status was 0. Rectal examination revealed a proliferative growth
starting 1 cm above the anal verge and ascending upwards and
involving the entire circumference with resultant obstruction of
the lumen of the rectum. Anal sphincter tone was lost. Computed tomography scan of the abdomen and pelvis revealed an
asymmetric circumferential wall thickening involving the entire
length of the rectum extending from the rectosigmoid junction
superiorly to the anal canal inferiorly, of size 15 × 5 cm, with
marked narrowing of the rectal lumen along with a few enlarged
336

Figure 1. CT of the abdomen showing asymmetric circumferential wall thickening
involving the entire length of the rectum.

lymph nodes at the perirectal and iliac levels (Figure 1). A large
nodular friable lesion narrowing the entire rectal lumen was
visualized by ﬂexible sigmoidoscopy and a biopsy was taken.
Histopathological examination showed collections of mediumsized lymphoid cells with scant cytoplasm and round nuclei
(Figure 2). On immunohistochemistry, the cells were positive
From the Department of Medical Oncology, Regional Cancer Center, Trivandrum
695011, India.
Corresponding author: Geetha Narayanan, MD, Department of Medical Oncology,
Regional Cancer Centre, Trivandrum 695011, India (e-mail: geenarayanan@yahoo.
com).
Proc (Bayl Univ Med Cent) 2017;30(3):336-337

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