Indicaciones de manejo quirúrgico en pacientes con Linfoma No Hodgkin primario de colon. Reporte de dos casos y revisión de la literatura

Abstract

Introduction: primary lymphomas of the colon corresponds to less than 1% of all colorectal neoplasms, The right colon is the segment most frequently affected. Diffuse B large cell is the most common histological variant.

Objective: describe two cases of patients with primary lymphoma of the colon, as well as to review the available bibliography, emphasizing the diagnostic approach and indications for surgical management of primary lymphomas of the colon.

Patients and methods: the cases of two patients of 38 and 62 years, with primary lymphomas of the colon are presented. One of them required emergency surgical management, while the other presented clinical manifestations for several weeks, which allowed preoperative studies and surgery scheduling. Both patients were managed with postoperative chemotherapy.

Results: primary lymphomas of the colon are found in 70% of the cases in the right colon. Its presentation in the descending colon and rectum is associated with a worse prognosis. Immunosuppression and inflammatory bowel disease are considered the most important risk factors in the development of primary lymphomas of the colon. The most common presenting symptoms are pain, abdominal mass, weight loss, and gastrointestinal bleeding. The therapeutic approach that has shown the best results is the combination of surgical resection and postoperative chemotherapy, in those patients considered to have resectable lesions.

Conclusions: primary colon lymphoma is a rare entity that requires a multidisciplinary approach. In patients who do not present with surgical emergency, abdominal tomography and PET-CT provide valuable information to define the feasibility and extent of surgical approach, which should be complemented with postoperative chemotherapy.