bubble_chart Overview

Cervical malignancy with cachexia (Malignant Lymphoma) is a malignant tumor originating from the lymphoreticular tissue. Large intestine cervical malignancy with cachexia includes primary extranodal lymphoma of the intestinal tract and secondary sexually transmitted disease changes involving the gastrointestinal tract during the course of cervical malignancy with cachexia from other sites. Primary cases have an insidious onset and lack specificity in the early stages, often leading to delayed diagnosis and treatment, resulting in a poor prognosis. It commonly occurs in the ileum and cecum, which are rich in lymphoid tissue, followed by the right colon. The distribution pattern may be localized but generally involves a wider range than carcinoma.

bubble_chart Clinical Manifestations

Fiberoptic colonoscopy is the primary method for diagnosing this condition. Under endoscopy, cervical malignancy with cachexia mainly presents as diffuse, polypoid, and ulcerative types, among other basic morphologies.

1. Diffuse type: Characterized by infiltration, the intestinal wall shows diffuse thickening and hardening. The affected segment loses its normal luster, with narrowing of the lumen and loss of peristalsis, which fails to expand even after air insufflation. The mucosal surface may exhibit thickened, cerebriform folds or diffuse nodular changes, accompanied by surface erosion or superficial ulcers, resembling infiltrative carcinoma but involving a wider area.

2. Polypoid type: The mass appears as a broad-based, smooth-surfaced or nodular polypoid lesion, often misdiagnosed as a benign polyp or polypoid carcinoma. Larger tumors may develop ulcers and bleeding, leading to luminal narrowing. Multiple hemispherical polyps of nearly equal size may also be observed, resembling benign lymphoid polyposis. The surface is smooth and white, but local infiltration often causes thickening, disappearance of haustra, rigidity, and loss of peristalsis.

3. Ulcerative type: Cervical malignancy with cachexia may exhibit malignant ulcer features, though some patients present with benign ulcer changes: flat, shallow ulcers with white coatings and flat margins. Additionally, there is an extraluminal mass type, caused by outward growth of the mass, which compresses the lumen, causing narrowing while the mucosal surface remains normal.

bubble_chart Auxiliary Examination

Fiberoptic colonoscopy is the primary method for diagnosing this condition, with a positive endoscopic detection rate as high as 50-80%. It is noteworthy that even when malignancy is highly suspected during endoscopy, biopsy pathology may only reveal inflammatory cell infiltration without evidence of cancer. This occurs because intestinal-type cervical malignancy with cachexia, despite having certain histological features such as atypical histiocytes and lymphocytes, pathological mitotic figures, and tissue structure destruction, often cannot be definitively diagnosed due to superficial sampling, small tissue fragments, or compression artifacts from forceps. Therefore, biopsy sampling for this disease differs from that for intestinal cancer; in addition to mucosal sampling, obtaining submucosal tissue is essential. When endoscopic findings repeatedly contradict pathological results, the possibility of this condition should be considered.