# A Rare Case of Synchronous Invasive Adenocarcinoma of the Colon and Marginal Zone Lymphoma of a Splenule Associated With Hemolytic Anemia

## TL;DR

A 63-year-old man presented with a rare combination of colon cancer and a lymphoma in an accessory spleen, along with signs of hemolytic anemia.

## Contribution

This is the first reported case of synchronous invasive colonic adenocarcinoma and splenule marginal zone lymphoma.

## Key findings

- The patient had a moderately differentiated colorectal adenocarcinoma.
- Splenomegaly with an accessory spleen was found to contain marginal zone lymphoma confirmed by flow cytometry.
- The case presented signs of hemolytic anemia, including spherocytosis and nucleated red blood cells.

## Abstract

This case report presents a rare and intriguing clinical scenario involving a 63-year-old male with recurrent left-sided hydroureteronephrosis, hypertension, and hyperlipidemia presenting with fatigue, dyspnea, and weight loss. Laboratory findings revealed anemia, basophilic stippling, spherocytosis, and nucleated red blood cells on the peripheral blood smear, raising concerns for hemolysis. Concomitant iron deficiency anemia led to further investigations, revealing gastritis and a colonic mass. A CT scan revealed splenomegaly with an accessory spleen. The histopathological evaluation identified splenic marginal zone lymphoma (MZL) - a diagnosis supported by flow cytometry. Simultaneously, the patient was found to have a moderately differentiated colorectal adenocarcinoma on colonoscopy. This unique case highlights a rare synchronous occurrence of invasive colonic adenocarcinoma with splenule MZL, an unprecedented finding in medical literature.