Clinical features and outcomes of duodenal‐type follicular lymphoma: A single‐center retrospective study

Abstract

Duodenal‐type follicular lymphoma (FL) is a rare and newly recognized disease. Few data are available on the outcomes and treatment strategies for patients with duodenal‐type FL. We aimed to investigate the clinical features and outcomes of duodenal‐type FL. We defined duodenal‐type FL as involvement of the duodenum, without nodal or extranodal lesions other than intestinal lesions, pathologically diagnosed as FL. We reviewed 26 patients with duodenal‐type FL between January 2011 and December 2020 at Kobe City Hospital Organization, Kobe City Medical Center General Hospital. In particular, patients were selected for the watch and wait (WW) strategy and followed up with regular esophagogastroduodenoscopy about once a year at our institution. The patient characteristics were as follows: median age 63.5 years (range: 42–78), sex (male, 15; female, 11), stage (I, 26), and grade (I, 26). Regarding treatment strategies, 23 patients were selected for the WW strategy, and three patients received initial rituximab therapy. The median follow‐up period was 65.5 months (range: 0.2–109). Five‐year progression‐free survival and 5‐year overall survival rates were 86.3% and 100%, respectively. Among the 23 patients selected for the WW strategy, six had spontaneous complete regression, and 14 had stable disease, and three had progressive disease, including one with histologic transformation. The WW strategy for patients with duodenal‐type FL could be an appropriate and safe treatment option. However, in several cases, disease progression was documented, and regular follow‐up is important.

Gastrointestinal Follicular Lymphoma: A Single-institutional Experience of 22 Cases With Emphasis on the Comprehensive Clinicopathological Analysis and Diagnostic Re-classification

“…However, the remaining patients presented with multifocal lesions involving the terminal ileum and duodenum. This finding is in agreement with recent data demonstrating that patients with DFL frequently have multiple lesions in the distal portion of the duodenum or other regions of the small intestine in addition to the second portion of the duodenum (20)(21)(22)(23). We assumed the possibility that in at least some patients with DFL, extraduodenal lesions might not be detected because of the lack of enteroscopic examination.…”

Role of Small Bowel Capsule Endoscopy in Determining the Treatment Strategy for Duodenal Follicular Lymphoma: A Single-Center Retrospective Study

“…Among the available treatment approaches for DFL, the wait-and-watch approach does not require the administration of immediate treatment. However, as mentioned earlier, there is a possibility of high-grade transformation necessitating continuous follow-up examinations [7,11]. Consequently, routine surveillance tests such as routine endoscopy, VCE, CT, and FDG-PET/CT are essential.…”

Incidental Finding of a Duodenal-Type Follicular Lymphoma in Metabolic Dysfunction-Associated Steatohepatitis Cirrhosis: A Rare Malignancy With Favorable Outcomes

“…Endoscopic findings are most frequently described as nodular polyps or mass-like lesions but have also been described as white granular or polypoid lesions observed in a pattern similar to lymphomatous polyposis. 2,6,[10][11][12][13][14] There are no established comorbidities or risk factors associated with GI-FL. However, location of the polyps within the GI tract appears to be an important factor associated with OS.…”

“…However, most studies have found DFL to be indolent with no clear difference in outcomes, including OS regardless of treatment approach. 4 , 7 , 10 , 24 , 25 …”