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Session: ePoster: Other Neoplasia and Endoscopy 8 (Sat315)

EP141 - A Rare Case of Diffuse Large B-cell Lymphoma Diagnosed in Longstanding Symptomatic Hemorrhoids

Saturday, May 10, 2025
3:25 PM – 3:30 PM PT
Location: Monitor 6, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Samuel H. Lai, MD

    Resident
    University of Colorado School of Medicine, Department of Surgery
    University of Colorado School of Medicine
    Aurora, CO, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • SV

    Sudheer Vemuru, MD

    Resident
    University of Colorado School of Medicine, Department of Surgery
    Aurora, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • AM

    Amber Moyer, MD

    Assistant Professor of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • MM

    Michael S. McNevin, MD

    Associate Professor of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Samuel H. Lai, MD: This individual has no financial relationships with ineligible companies.
Sudheer Vemuru, MD: This individual has no financial relationships with ineligible companies.
Amber Moyer, MD: This individual has no financial relationships with ineligible companies.
Michael S. McNevin, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: While hemorrhoidal disease is commonly found, with an estimated prevalence of up to 40%, in rare cases, lymphoma can be found masquerading as benign symptomatic hemorrhoids. Here we present a case of a 67-year-old female with 2-year history of symptomatic mixed internal and external hemorrhoids who underwent an excisional hemorrhoidectomy complicated by significant blood loss requiring transfusion and diagnosis of diffuse large B-cell lymphoma (DLBCL) on pathology.

Methods/Interventions: A 67-year-old female with history of osteopenia and left breast invasive ductal carcinoma with lumpectomy and whole breast radiation in her thirties presented to colorectal surgery clinic for evaluation of worsening symptomatic hemorrhoids that have been present for at least 2-3 years with intermittent bright right blood per rectum. Physical exam showed grade 3 internal hemorrhoid and external hemorrhoidal skin tags. Routine screening colonoscopy 2 years prior showed only mixed internal and external hemorrhoids. She had no improvement of symptoms with previous nonoperative management and desired surgical treatment of her hemorrhoids. She underwent open 3-column excisional hemorrhoidectomy for complex grade 3 mixed hemorrhoids with large external component and hypertrophied anal papillae, which were sent to pathology.

Intraoperatively, there was persistent bleeding totaling around 300cc that required significant effort for hemostasis. Postoperatively, she had mild bleeding per anus with hemoglobin of 6.9 requiring 2 units of packed red blood cell transfusion. She was discharged on postoperative day 2 after resolution of bleeding. Her pathology subsequently revealed DLBCL with lymphocytic infiltrate of large atypical lymphoid cells involving the mucosal tissue. PET/CT showing multiple nodal and extranodal (rectosigmoid, anal canal, small bowel, pulmonary, and bone marrow) involvement. Additional workup was negative for Epstein–Barr Virus (EBV), normal TP53, MYC, BCL2 and BCL6.

Results/Outcomes: Initial chemotherapy with dose adjusted EPOCH-R was initiated 2 weeks after hemorrhoidectomy. She was then transitioned after cycle 1 to R-CHP plus polatuzumab (pola-R-CHP) per POLARIX trial and completed 5 cycles 3 months later. Initial follow up PET/CT 1 month after chemotherapy showed concern for continued FDG avidity in rectum. Subsequent colonoscopic biopsy and exam under anesthesia with anoscopy were without evidence of lymphoma recurrence. PET/CT 3 months after chemotherapy showed stable findings and she remained asymptomatic on most recent surveillance visit.

Conclusion/Discussion: While gastrointestinal involvement of lymphoma is more commonly seen, findings of malignant lymphoma in hemorrhoidal tissue is extremely rare, described only by a handful of case reports. Clinicians should be aware of how these may present, including as hemorrhoids and perianal abscesses, as well as general work up and treatment for suspected anorectal lymphoma.