P4621 - An Uncommon Culprit: DLBCL Presenting in the Colon

Christin Wilkinson, MD¹, Jinye Liu, DO¹, Abdul Aziz Swaiti, MD², Clarimar Diaz-Lopez, MD¹, Rami Basmaci, MD¹, Christina Santana, MD¹, Stephanie Ibarra Lepe, MD¹, Romina Nomigolzar, MD¹, Sarah Jahangir, MD¹, Deniz Coskuner, MD¹, Alina Faheem, MD¹, Khaled Elhusseiny, MD¹, Saeed S. Graham, MD³, Huai-En Chang, MD, MPH, MBA¹, Hassam Ali, MD¹, Kara Regan, MD⁴
1East Carolina University Medical Center, Greenville, NC; 2East Carolina University, Greenville, NC; 3ECU Department of Internal Medicine, Greenville, NC; 4East Carolina Gastroenterology, Greenville, NC

Introduction:

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL) in the U.S., arising from B, T, or NK lymphocytes. Extranodal involvement is common, especially in the gastrointestinal (GI) tract, with the stomach being the most frequently affected site. In contrast, primary colorectal DLBCL is rare, accounting for less than 1% of all primary colorectal malignancies.

Case Description/

Methods:

A 64-year-old male with a history of HTN and b/l OA, presented for screening colonoscopy due to prior adenomatous polyps. He was asymptomatic. Colonoscopy showed a neoplastic-appearing 30 cm sigmoid mass; bx confirmed DLBCL. CT showed a mass at the sigmoid junction with small (< 9 mm) paracolic, mesenteric, and para-aortic lymphadenopathy. Bone marrow bx was negative. He completed four cycles of CHOP chemotherapy, post-treatment PET scan showed persistent but improved sigmoid hypermetabolism post radiation therapy. Repeat colonoscopy found segmental inflammation from 18–30 cm without lymphoma on biopsy. PET scan showed disease progression with a larger hypermetabolic mass at the sigmoid junction and new LL quadrant adenopathy. He was started on ICE chemotherapy for two cycles. His course was complicated by colonic obstruction due to radiation colitis, requiring a diverting colostomy and persistent obstruction due to mass effect led to failure to thrive and PEG tube placement. He was transitioned to home hospice and later passed away.

Discussion:

DLBCL is the most common subtype of non-Hodgkin lymphoma, accounting for 25–30% of cases. NHL represents about 80% of all lymphomas and includes over 30 subtypes, with DLBCL and follicular lymphoma being the most prevalent. DLBCL typically presents as a rapidly enlarging mass in either nodal or extranodal sites.

While nodal involvement is more common, originating in lymph nodes, spleen, or thymus, 30–40% of DLBCL cases are extranodal. The GI tract is a frequent extranodal site, with the stomach involved in 65% of GI cases, the small intestine in 20–35%, and the colon and rectum in only 5–15%. Colonic DLBCL is rare and often asymptomatic, sometimes discovered incidentally during routine screening, as in our patient. Treatment is typically based on histologic subtype, stage, and comorbidities, with R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) being the standard first-line regimen. Management may also include surgery or radiation in selected cases.

Disclosures:
Christin Wilkinson indicated no relevant financial relationships.
Jinye Liu indicated no relevant financial relationships.
Abdul Aziz Swaiti indicated no relevant financial relationships.
Clarimar Diaz-Lopez indicated no relevant financial relationships.
Rami Basmaci indicated no relevant financial relationships.
Christina Santana indicated no relevant financial relationships.
Stephanie Ibarra Lepe indicated no relevant financial relationships.
Romina Nomigolzar indicated no relevant financial relationships.
Sarah Jahangir indicated no relevant financial relationships.
Deniz Coskuner indicated no relevant financial relationships.
Alina Faheem indicated no relevant financial relationships.
Khaled Elhusseiny indicated no relevant financial relationships.
Saeed Graham indicated no relevant financial relationships.
Huai-En Chang indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Kara Regan indicated no relevant financial relationships.

Christin Wilkinson, MD¹, Jinye Liu, DO¹, Abdul Aziz Swaiti, MD², Clarimar Diaz-Lopez, MD¹, Rami Basmaci, MD¹, Christina Santana, MD¹, Stephanie Ibarra Lepe, MD¹, Romina Nomigolzar, MD¹, Sarah Jahangir, MD¹, Deniz Coskuner, MD¹, Alina Faheem, MD¹, Khaled Elhusseiny, MD¹, Saeed S. Graham, MD³, Huai-En Chang, MD, MPH, MBA¹, Hassam Ali, MD¹, Kara Regan, MD⁴. P4621 - An Uncommon Culprit: DLBCL Presenting in the Colon, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.