A unique case of colorectal lymphoma in a 39-week intrauterine pregnant female.

Dear Editor: I wish to present a case study with a unique clinical presentation of colorectal lymphoma in a HIV-negative patient without any other underlying immunosuppressive conditions. Gastrointestinal lymphoma is the most common extranodal site of lymphoma [1]. Primary gastrointestinal lymphomas only account for 1–4 % of all gastrointestinal malignancies [1]. The most common involved sites of gastrointestinal lymphomas are usually the stomach followed by the small bowel and ileocecal region [1]. Colorectal lymphoma is rare as it accounts for 1.4 % of all gastrointestinal lymphomas and only 0.1–0.5 % of colorectal malignancies [2]. Immunodeficiency and immunosuppression are common predisposing factors that are associated with an increase incidence of lymphoma [1]. Particular risk factors have been associated in the pathogenesis of gastrointestinal lymphoma including Helicobacter pylori infection, Campylobacter jejuni, human immunodeficiency virus, Epstein-Barr virus, human T-cell lymphotropic virus-1, celiac disease, and inflammatory bowel disease [1]. Most cases of colorectal lymphomas are non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma is a heterogenous disease caused by the malignant transformation of lymphocytes. Non-Hodgkin’s lymphoma is the 7th most common cancer in the USAwith currently 172,937 cases diagnosed in 2013. It is expected that around 20,200 people have died from nonHodgkin’s lymphoma in 2013. The disease remains more common in men but has increased in incidence by 1.1 % per year for women since 1990. The predominant subtypes found in the colon are as follows: diffuse large cell B-cell lymphoma (60 %), followed by marginal zone B-cell lymphoma of mucosa associated lymphoid tissue type (15 %), and Burkitt’s lymphoma (15 %) [3]. Diffuse large B-cell lymphomas (DLBCL) can develop de novo or as a transformation from a less aggressive type of lymphoma. DLBCL appear as large, atypical lymphoid cells with prominent nuclei and basophilic cytoplasm that obliterate normal tissue in a diffuse pattern [1–3]. DLBCL generally express positive markers such as CD-19, CD-20, CD-22, and CD79a [1–3]. Mucosa associated lymphoid tissue type (MALT) are indolent, mature B-cell lymphomas that can arise from chronic inflammation or autoimmune disorders, where inflammation causes abnormal lymphoid cells to grow rapidly and replace normal tissue [3]. Indolent lymphomas are not considered curable because the cancer grows too slowly to be targeted accurately. Burkitt’s lymphoma (BL) arises from proliferation and deregulation of the c-MYC gene t(8;14) [3]. BL can arise sporadically, endemically, or with immunodeficient populations and are usually differentiated by the patient’s clinical environment [3]. The most important prognostic factor in western intestinal lymphomas is clinical stage. There is a 5-year survival rate of 40–50 % in Stage I–II, and a 10 % 5-year survival for those with stage IV lymphoma [4]. Surgical resection is the principal treatment for localized intestinal lymphomas and has become a major role in early stage disease because of the chemotherapy has a variable response on lymphomas. There are very few cases of colorectal lymphomas. Most of the cases of colorectal lymphoma are related to HIV-infected patients [3]. We report a case of a 22-year-old G1P1 female with 39 week intrauterine pregnancy who presented with rectal bleeding and myalgia. This is a unique case of a M. El-Hajjaoui (*) Western University of Health Sciences, 309 E. 2nd Street, Pomona, CA 91766, USA e-mail: m.elhajjaoui@gmail.com