1. 울산의대 강릉아산병원 소화기내과 내 시 경 집 담 회 발표자 : 정 형 주

2. C A S E Chief Complaint intermittent blood-tinged stool with ext. hemorrhoid Present Illness 2 년 전 primary clinic 에서 CFS 검사상 특이소견 없었던 자로 같은 해 2 달 후 Duodenal stricture d/t duodenal ulcer 로 Duodenojejunostomy 를 시 행하였고 최근 Ext. hemorrhoid Op 위해 본원 GS 방문 후 시행한 CFS 상 Rectal mass 있어 입원. 60/M

3. Past/Social/Family Hx Past History duodenal stricture d/t duodenal ulcer → duodenojejunostomy (07. 9. 21) Social History Smoking (-) Alcohol (-) Family History Non-specific

4. ROS & PEx ROS : fever/weight loss/night sweat (-/-/-) General/HEENT/Chest/Abdomen/Genitourinary : Non-specific Physical Examination V/S : 120/90 – 78 – 16 – 36.8 ℃ HEENT/Chest/Abdomen/Genitourinary : Non-specific

5. Initial Lab Findings CBC 5800x10 3 /mm 3 -12g/dL-38%-339k/mm 3 Chemistry TP/Alb 5.8 / 3.8 g/dL AST/ALT/ALP 13 / 21 / 418 IU/L T-bil 0.3 mg/dL BUN/Cr 15 / 1.3 mg/dL Na/K/Cl 143 / 4.4 / 106 mEq/L LDH 184 mg/dL Tumor marker : CEA 1.1 IU/mL

6. Colonoscopic Findings (09.3.3 )

7. Histologic Findings

8. CD 20

9. A-P CT ( 09.3.10 )

10. PET CT ( 09.3.19 )

11. Bone Marrow Exam No involvement of lymphoma

12. Diagnosis Rectal non-Hodgkin’s lymphoma Diffuse large B-cell lymphoma Ann Arbor stage : IV IPI : 1 ( Age ≥ 60 )

13. Clinical Course ChemoTx R-CHOP #1 (2009.3.27) R-CHOP #2 (2009. 5. 4) R-CHOP #3 (2009. 6. 9)

14. A-P CT ; post R-CHOP#1

15. Brief Review ; Colorectal Lymphoma Incidence - primary colorectal lymphoma is rare - 0.2-0.6% of all colorectal malignancies - 1.4% of human lymphomas - 10~20% of GI lymphomas Location - cecum : 60-74% - rectum : 14.3% Colorectal Disease 2006;8:586 The American Journal of Surgery 2007;193:409

16. Brief Review ; Colorectal Lymphoma M/C Histologic Subtype - MALT lymphoma - diffuse large B cell lymphoma Risk Factors - immunosuppression ( post-transplant or immune disorders) - HIV positivity Colorectal Disease 2006;8:586 The American Journal of Surgery 2007;193:409

17. Treatment - no randomized control trials resection with adjuvant chemoTx vs. chemoTx ± RTx - surgery for pain, obstruction or bleeding Colorectal Disease 2006;8:586 The American Journal of Surgery 2007;193:409 Dis Colon Rectum 2000;43:1277 Brief Review ; Colorectal Lymphoma