A case of EBV-Negative Primary Intestinal Diffuse Large B Cell Lymphoma Involving Multiple Anatomic Sites and Lymph Nodes

Abstract Introduction/Objective Extranodal lymphomas in the gastrointestinal tract are rare, with colonic lymphomas representing less than 0.5% of colorectal neoplasms. The most common type is Non-Hodgkin lymphoma. Treatment typically involves chemotherapy and surgical resection, with prognosis depends on various factors including age, genetic alteration, and bone marrow involvement. Methods/Case Report An 82-year-old female patient presented with abdominal pain and constipation. Radiological imaging revealed a mass in the ascending colon extending to the ileum. Histological examination following biopsy revealed to be a diffuse large B-cell lymphoma (DLBCL) of germinal center origin. The resected specimen showed two separate centrally ulcerated fungating masses in the ileum (4 x 4 x 1 cm) and ascending colon (8.5 x 5 x 4 cm). Microscopic examination showed a diffuse infiltrate of large, discohesive, atypical lymphoid cells with vesicular chromatin and prominent nucleoli. Abundant mitoses and apoptotic bodies are evident. The lesional cells were diffusely infiltrating into the lamina propria, submucosa, muscularis propria, and serosa associated with geographic necrosis. The appendix was also transmurally involved by the neoplastic cells. Multiple pericolonic lymph nodes were also involved by the lesional cells (6/15). Immunnohistochemical stains showed the neoplastic cells are positive for CD20, CD10, BCL6, while negative for MUM1, BCL2, C-MYC, and EBER. Ki67 index was 70%. CMV was negative. FISH result for MYC gene rearrangement with reflex to BCL2 and BCL6 was negative, which excludes double/triple-hit high grade B-cell lymphomas. The patient received chemotherapy with R-CHOP after the surgery and stayed recurrence-free for 15 months. Results (if a Case Study enter NA) NA Conclusion We reported a case of EBV-negative primary intestinal diffuse large B-cell lymphoma with germinal center cell origin involving multiple anatomic sites and pericolonic lymph nodes in an elderly immunocompetent woman.