A case of mucosa-associated lymphoid tissue lymphoma forming multiple lymphomatous polyposis in the small intestine

Article (PDF Available)inWorld Journal of Gastroenterology 13(9):1453-7 · April 2007with39 Reads
Source: PubMed
Abstract
A 50-year old woman suffering from diabetes had a CT scan that revealed a diffuse thickening of small intestinal wall and swollen paraaortic lymph nodes. An esophagogastroduodenoscopy (EGD) confirmed multiple polypoid lesions in the duodenum and small intestine, and conventional histological testing revealed non-specific inflammatory changes. Further examinations including the immunohistochemical profiles of the biopsied specimens led us to diagnose the lesion as a marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type, forming multiple lymphomatous polyposis sequentially spreading from duodenal bulb to terminal ileum. According to Lugano's classification, its staging was clinically diagnosed as stage II. Two courses of a standard CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and predonisolone) regimen with rituximab reduced the lesion and the patient had a almost complete response. A 5-year follow-up EGD and histological examinations detected no recurrence of the disease.
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World Journal of Gastroenterology
ISSN 1007-9327
wjg@wjgnet.com © 2007 The WJG Press. All rights reserved.
A case of mucosa-associated lymphoid tissue lymphoma
forming multiple lymphomatous polyposis in the small
intestine
Naoto Hirata, Kazunari Tominaga, Kensuke Ohta, Kaori Kadouchi, Hirotoshi Okazaki, Tetsuya Tanigawa,
Masatsugu Shiba, Toshio Watanabe, Yasuhiro Fujiwara, Shiro Nakamura, Nobuhide Oshitani, Kazuhide Higuchi,
Tetsuo Arakawa
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CASE REPORT
Naoto Hirata, Kazunari Tominaga, Kensuke Ohta, Hirotoshi
Okazaki, Tetsuya Tanigawa, Masatsugu Shiba, Toshio
Watanabe, Yasuhiro Fujiwara, Shiro Nakamura, Kazuhide
Higuchi, Tetsuo Arakawa,
Department of Gastroenterology,
Osaka City University Graduate School of Medicine, 1-4-3
Asahimachi, Abeno-ku, Osaka 545-8585, Japan
Kensuke Ohta,
Department of Hematology, Osaka City
University Graduate School of Medicine, 1-4-3 Asahimachi,
Abeno-ku, Osaka 545-8585, Japan
Shiro Nakamura,
Department of Gastroenterology, Rinku
General Medical Center, 2-3 Rinkuouraikita, Izumisano, Osaka
598-0048, Japan
Supported in part by
a Grant-in-Aid for Scientic Research (C)
from the Ministry of Education, Science and Culture in Japan
Correspondence to:
Kazunari Tominaga, Department of
Gastroenterology, Osaka City University Graduate School of
Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585,
Japan. tomy@med.osaka-cu.ac.jp
Telephone:
+81-6-66453811
Fax:
+81-6-66453813
Received:
2006-12-16
Accepted:
2007-03-03
Abstract
A 50-year old woman suffering from diabetes had a CT
scan that revealed a diffuse thickening of small intestinal
wall and swollen paraaortic lymph nodes. An esophago
gastroduodenoscopy (EGD) conrmed multiple polypoid
lesions in the duodenum and small intestine, and
conventional histological testing revealed non-specific
inflammatory changes. Further examinations including
the immunohistochemical profiles of the biopsied
specimens led us to diagnose the lesion as a marginal
zone B-cell lymphoma of mucosa-associated lymphoid
tissue type, forming multiple lymphomatous polyposis
sequentially spreading from duodenal bulb to terminal
ileum. According to Lugano’s classification, its staging
was clinically diagnosed as stage
. Two courses of
a standard CHOP (cyclophosphamide, doxorubicin
hydrochloride, vincristine sulfate, and predonisolone)
regimen with rituximab reduced the lesion and the
patient had a almost complete response. A 5-year follow-
up EGD and histological examinations detected no
recurrence of the disease.
© 2007 The WJG Press. All rights reserved.
Key words:
Intestinal lymphoma; Mucosa-associated
lymphoid tissue lymphoma; Multiple lymphomatous
polyposis
Hirata N, Tominaga K, Ohta K, Kadouchi K, Okazaki H,
Tanigawa T, Shiba M, Watanabe T, Fujiwara Y, Nakamura
S, Oshitani N, Higuchi K, Arakawa T. A case of mucosa-
associated lymphoid tissue lymphoma forming multiple
lymphomatous polyposis in the small intestine.
World J
Gastroenterol
2007; 13(9): 1453-1457
http://www.wjgnet.com/1007-9327/13/1453.asp
INTRODUCTION
Lymphomas in the gastrointestinal (GI) tract may be
ulcerative, superficial, polypoid, or diffuse, and may
also have other less common characteristics
[1]
. Multiple
lymphomatous polyposis (MLP) is characterized by the
formation of multiple mucosal polyps
[2]