Development of diffuse large B-cell lymphoma from duodenal type follicular lymphoma: a retrospective study of 23 cases

Saburi, Masuho; Kondo, Yoshiyuki; Ogata, Masao; Soga, Yasuhiro; Abe, Miyuki; Takano, Kuniko; Kohno, Kazuhiro; Nagai, Takayuki; Nakayama, Toshiyuki

doi:10.1007/s12185-020-02957-z

Cited by 8 publications

(9 citation statements)

References 24 publications

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“…Watch and wait strategy is recommended in most cases with GI tract FL due to clinical indolent behaviors and a very low incidence of transformation to DLBCL. On the contrary, recent retrospective analysis by Saburi et al showed that histological transformation to DLBCL was observed in two cases (8.7%) among total 23 cases with duodenal FL (14). Thus, occurrence of histological transformation to DLBCL is not so rare and careful follow-up is absolutely required even for cases with indolent FL of the GI tract.…”

Section: Discussionmentioning

confidence: 96%

Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma

et al. 2021

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Double expressor lymphoma (DEL), defined as overexpression of BCL2 and MYC, is an aggressive subtype of diffuse large B cell lymphoma (DLBCL). Here we report a case of a 64-year-old female diagnosed with abdominal DEL transformed from jejunum follicular lymphoma (FL). 18F-fluorodeoxyglucose (FDG)-positron emission tomography showed diffuse accumulation of FDG into the peritoneum and small bowel wall. Double balloon-assisted enteroscopy revealed whitish submucosal tumors in the proximal jejunum. Aggregation of atypical lymphocytes positive for CD20, CD79a, and BCL2 was seen in the jejunal biopsy samples. These atypical lymphocytes were monoclonal since cell surface expression of Ig light chains was limited to κ chain by flow-cytometry. Thus, immunohistochemical and flowcytometric analyses data were consistent with FL of the jejunum. Neoplastic lymphocytes obtained from ascites were positive for CD10, CD20, CD79a, BCL2, and BCL6. Fluorescence in situ hybridization (FISH) showed formation of BCL2/IgH fusion gene and extra copies of MYC, the former of which is a characteristic chromosomal abnormality of FL. These genetic alterations and protein expression profiles of ascitic fluid cells were consistent with those of DEL transformed from FL. Given that a significant population of patients with indolent FL of the gastrointestinal tract developed into aggressive DLBCL, it is likely that primary FL of the jejunum transformed into the abdominal aggressive DEL in this case. This case is unique in that concurrent occurrence of FL and DEL was confirmed by immunohistochemical and FISH analyses and that abdominal DEL transformed from jejunal FL was highly suspected.

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Section: Discussionmentioning

confidence: 96%

Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…In contrast, although relatively rare, patients with DFL have a risk of progression (<10%) and HT (3.8%) [ 4 , 8 ]. Progression including HT could occur in DFL at any time, even after 5 years [ 8 , 16 ]. Moreover, it is difficult to stratify prognosis using the international prognostic index or follicular lymphoma international prognostic index in DFL, and there are no methods to predict prognosis or progression in DFL [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, an appropriate long‐term follow‐up strategy is important in patients with DFL, especially those selected for the WW strategy, because it may help us to detect the progression and treat it appropriately. There is no evidence for the interval of follow‐up in patients with DFL [ 15 ], and there are various reports on follow‐up intervals ranging from 4 to 12 months [ 8 , 13 , 15 , 16 ]. In our study, follow‐up included annual EGD, and we could detect progression (in four patients), and no deaths were attributed to DFL.…”

Section: Discussionmentioning

confidence: 99%

“…Duodenal‐type FL (DFL), which was recognized in the 2017 World Health Organization classification, is a rare and specific variant of FL that is predominantly involved in the second portion of the duodenum [ 4 ]. In general, DFL has a very indolent clinical course and an excellent prognosis but rarely progresses, including histologic transformation (HT) [ 4 , 5 , 6 , 7 , 8 ]. Although the watch and wait (WW) strategy is frequently applied, there is no consensus regarding the treatment [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

Kamijo

Shimomura

Yoshioka

et al. 2022

eJHaem

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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.

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Duodenal Follicular Lymphoma: Track or Treat?

et al. 2022

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Duodenal follicular lymphoma (DFL) is a rare variety of non-Hodgkin's lymphoma of the gastrointestinal tract that usually carries a favorable course, recognized as a new entity in 2016. It is usually diagnosed at an early stage located predominantly in the second portion of the duodenum. We report the case of a 74-year-old male patient with epigastric pain in whom gastroscopy revealed white mucosal nodules that were pathologically diagnosed as grade 1-2 DFL. Staging investigations revealed secondary lesions in the spleen and at the base of the tongue together with latero-cervical adenopathy. The tumor was stage IV according to the Lugano staging system. We reviewed the recent (last five years) literature defining the importance of combination therapy in the advanced stage. The patient achieved complete remission of the disease through chemoimmunotherapy following the Rituximab-Bendamustine scheme.

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Development of diffuse large B-cell lymphoma from duodenal type follicular lymphoma: a retrospective study of 23 cases

Cited by 8 publications

References 24 publications

Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma

Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma

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

Duodenal Follicular Lymphoma: Track or Treat?

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