Colorectal follicular lymphoma: A single-center retrospective study

Abstract

BACKGROUND

The concept of “duodenal-type follicular lymphoma (FL)” has already been established as a disease entity. On the other hand, because FL that develops in the colorectum is a rare disease, its clinical characteristics, including its treatment and outcome, are poorly understood.

AIM

To clarify the characteristic clinical features of colorectal FL.

METHODS

We identified 5 patients with FL from December 2010 to July 2022 whose colorectal lesions were confirmed by endoscopic biopsy at our hospital and retrospectively examined their clinical features, including endoscopic findings, treatment, and long-term outcomes.

RESULTS

The median age of the patients was 70 years (range 62-74 years, 3 males and 2 females), and 2 patients were considered to have systemic FL lesions. Endoscopic findings revealed elavated lesions in all 5 patients (polypoid 3, flat elavated 1, papular 1). Only 1 patient underwent therapeutic intervention, and 4 patients chose watchful waiting. Except for 1 patient in which the lesion spontaneously regressed, the disease recurred or progressed in 4 patients, 3 of whom eventually achieved near complete remission with the administration of rituximab and bendamustine (± polatuzumab vedotin). The 5 patients in this study were still alive or exhibited long-term survival before death; the survival time ranged from 8-29 years after the onset of lymphoma.

CONCLUSION

In the present study, colorectal FL progressed slowly, and overall survival was good because it was sensitive to anticancer drugs even after the disease progressed without initial therapeutic intervention.

Keywords: Follicular lymphoma; Colorectum; Duodenal-type follicular lymphoma; Endoscopic findings; Treatment; Long-term outcome

Core Tip: Follicular lymphoma (FL) occurring in the duodenum has already been established as a disease concept within the category of FL. In response to this, clinical characteristics of the colorectal FL, including its treatment and long-term outcome, are poorly understood owing to the rarity. This study aimed to clarify the characteristic clinical features of the colorectal FL. In the present study, colorectal FL progresses indolently, as with cases of nodal or duodenal lesions, and the overall survival was good because it was sensitive to chemotherapy with administration of bendamustine and rituximab even after the disease progressed without initial treatment.