Primary colonic lymphoma as an uncommon cause of large bowel obstruction: a case report
- 1Department of Surgery, Hudson Regional Health, Bayonne, NJ, USA
- 2Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
Abstract
Introduction and importance:: Primary colonic lymphoma (PCL) is a rare extranodal manifestation of non-Hodgkin lymphoma, accounting for a small fraction of colorectal malignancies. Due to its low incidence and nonspecific clinical and radiological features, PCL is frequently misdiagnosed as colonic adenocarcinoma. Optimal management remains poorly defined, and current treatment strategies rely on retrospective data and expert consensus.
Case presentation:: We report the case of a 69-year-old woman who presented with right lower quadrant abdominal pain and was found to have a near-obstructing ascending colon mass with extensive regional and retroperitoneal lymphadenopathy on computed tomography. Colonoscopic biopsies were nondiagnostic despite a malignant-appearing lesion. Given impending obstruction, the patient underwent an open right hemicolectomy with primary anastomosis. Histopathologic and immunohistochemical analysis of the surgical specimen revealed diffuse large B-cell lymphoma (DLBCL). Postoperative staging with positron emission tomography demonstrated fluorodeoxyglucose-avid nodal disease. The patient was treated with adjuvant immunochemotherapy and radiotherapy, achieving a complete metabolic response on follow-up imaging.
Clinical discussion:: This case highlights the diagnostic challenges of PCL and emphasizes the importance of surgical resection in symptomatic patients for both definitive diagnosis and management. DLBCL is the most common PCL subtype and responds favorably to multimodal therapy, including rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone–based chemotherapy. Positron-emission tomography–computed tomography plays a critical role in staging and assessment of treatment response.
Conclusion:: PCL should be considered in the differential diagnosis of colonic masses, particularly when biopsy results are inconclusive. A multidisciplinary, multimodal treatment approach can lead to favorable outcomes. Further prospective studies are needed to establish standardized management guidelines.
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BibTeX
@article{kostara2026primary,
title = {{Primary colonic lymphoma as an uncommon cause of large bowel obstruction: a case report}},
author = {Konstantina Kostara and Brandon Velazquez and Samantha Walkow and Tiffany Battagliola and Zbigniew Moszczynski},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = oct,
doi = {10.1097/rc9.0000000000001081},
url = {https://doi.org/10.1097/rc9.0000000000001081},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Primary colonic lymphoma as an uncommon cause of large bowel obstruction: a case report
AU - Konstantina Kostara
AU - Brandon Velazquez
AU - Samantha Walkow
AU - Tiffany Battagliola
AU - Zbigniew Moszczynski
PY - 2026
DA - 2026/10/06
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001081
UR - https://doi.org/10.1097/rc9.0000000000001081
AB - Introduction and importance:: Primary colonic lymphoma (PCL) is a rare extranodal manifestation of non-Hodgkin lymphoma, accounting for a small fraction of colorectal malignancies. Due to its low incidence and nonspecific clinical and radiological features, PCL is frequently misdiagnosed as colonic adenocarcinoma. Optimal management remains poorly defined, and current treatment strategies rely on retrospective data and expert consensus. Case presentation:: We report the case of a 69-year-old woman who presented with right lower quadrant abdominal pain and was found to have a near-obstructing ascending colon mass with extensive regional and retroperitoneal lymphadenopathy on computed tomography. Colonoscopic biopsies were nondiagnostic despite a malignant-appearing lesion. Given impending obstruction, the patient underwent an open right hemicolectomy with primary anastomosis. Histopathologic and immunohistochemical analysis of the surgical specimen revealed diffuse large B-cell lymphoma (DLBCL). Postoperative staging with positron emission tomography demonstrated fluorodeoxyglucose-avid nodal disease. The patient was treated with adjuvant immunochemotherapy and radiotherapy, achieving a complete metabolic response on follow-up imaging. Clinical discussion:: This case highlights the diagnostic challenges of PCL and emphasizes the importance of surgical resection in symptomatic patients for both definitive diagnosis and management. DLBCL is the most common PCL subtype and responds favorably to multimodal therapy, including rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone–based chemotherapy. Positron-emission tomography–computed tomography plays a critical role in staging and assessment of treatment response. Conclusion:: PCL should be considered in the differential diagnosis of colonic masses, particularly when biopsy results are inconclusive. A multidisciplinary, multimodal treatment approach can lead to favorable outcomes. Further prospective studies are needed to establish standardized management guidelines.
SN - 2210-2612
ER -