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Small lymphocytic lymphoma transformed into aggressive diffuse large B-cell lymphoma, a rare Richter syndrome case. This transformation presented with extranodal involvement in the sigmoid colon, an exceptionally uncommon site.

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Gastroenterology

Background:

  • Small lymphocytic lymphoma (SLL) is an indolent non-Hodgkin lymphoma.
  • Richter syndrome (RS) is the transformation of SLL into a more aggressive lymphoma, occurring in 2-8% of cases.
  • Extranodal involvement can occur in lymphoma but is typically more common in certain sites.

Observation:

  • A 75-year-old male with SLL presented with cervical swelling, suspected relapse.
  • F-FDG PET/CT revealed intense uptake in cervical, subdiaphragmatic lymph nodes, and left parotid.
  • PET/CT also showed diffuse colonic uptake and wall thickening.

Findings:

  • Endoscopy and biopsy confirmed diffuse large B-cell lymphoma (DLBCL) in the colon.
  • This represents a rare case of Richter syndrome with extranodal DLBCL.
  • The sigmoid colon is an extremely rare site for this transformed lymphoma.

Implications:

  • Highlights the importance of considering Richter syndrome in SLL patients with disease progression.
  • Underscores the utility of F-FDG PET/CT in detecting and staging lymphoma transformation.
  • Reports an exceptionally rare extranodal site for transformed lymphoma, expanding the spectrum of clinical presentation.