Management of Rectal lymphoma in a renal transplant patient- experience from the developing world

Abstract

Danish, et al.: Rectal lymphoma post renal transplantation 128 Asian Journal of Medical Sciences | Jun 2021 | Vol 12 | Issue 6 rectal examination had shown an increased anal tone, with a palpable mass 2cm away from anal verge at posterior wall, which was soft and mobile. So a sigmoidoscopy was done which showed mild to moderate erythema and edema with loss of vascularity seen involving rectum and distal sigmoid. Multiple biopsies were taken. The biopsy revealed it to be a low-grade non-Hodgkin lymphoma based upon morphological and immunohistochemical stains (IHC markers were applied and showed CD79a, CD 20 both to be patchy positive, while CD 3,5 and 43 were positive in the background cells, Mum1 was positive and Ki67 was positivity in <5% of atypical lymphoid cell) as shown in Image I and II. Hence, we proceeded with a CT scan Chest, Abdomen and Pelvis (CT CAP) which showed minimal asymmetrical soft tissue thickening seen in the distal rectum just above the internal sphincter. It measured 6mm in maximum dimension. No definite evidence of a mass lesion was identified nor any evidence of lymphadenopathy was noted. Rest of the scan was normal. A PET CT scan was advised after oncological consult, which showed a FDG avid mural thickening involving left posterolateral part of rectum, maximum thickness measures 1.3cm.No other abnormal FDG avid lesion was seen. The oncologist was again consulted and 4 cycle of CHOP with Rituximab 375mg\\m2 three weekly were given and for response evaluation a repeat PET scan was advised. The repeat PET scan showed normal uptake with mild FDG mural thickening involving the posterior wall of the rectum. As compared to previous scan there was a slight interval decrease in size of the lesion in the rectum seen.