Impact of double-balloon endoscopy on the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas: a case series

Higuchi, Naomi; Sumida, Yorinobu; Nakamura, K.; Itaba, Soichi; Yoshinaga, Shigetaka; Mizutani, Tomohiro; Honda, Kazuo; Taki, Kentaro; Murao, Hiroyuki; Ogino, Hitoshi; Kanayama, Kenji; Akiho, Hirotada; Goto, Ayako; Segawa, Yuichi; Yao, Takashi; Takayanagi, Ryoichi

doi:10.1055/s-0028-1119467

Cited by 33 publications

(34 citation statements)

References 14 publications

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“…For example, in our previous report, 46 of 54 duodenal follicular lymphoma patients (85.2%) who underwent whole gastrointestinal tract surveillance had extensive involvement within the small intestine, predominantly in the jejunum (i.e., 40 of 54 patients, 74.1%) [44] . These data are consistent with those reported in other studies where the percentage of patients with multiple lymphoma lesions in the small intestine ranged from 66.7% to 100% [29,[46][47][48][49] . Therefore, in combination, these results suggest that 18F-FDG-PET represents a complementary method for assessing gastrointestinal involvement of follicular lymphoma.…”

Section: Discussionsupporting

confidence: 83%

“…In 2004, Hoffmann et al [26] reported eight cases of follicular lymphoma localized in the duodenum, and 18F-FDG did not accumulate in any of those patients. Subsequently, several authors described follicular lymphoma patients with positive 18F-FDG uptake in the gastrointestinal tract, including the stomach, duodenum, jejunum, ileum, cecum, and colon [27][28][29][30] . However, a limited number of these cases have been reported Therefore, the sensitivity of 18F-FDG-PET for gastrointestinal lesions of follicular lymphoma has not been sufficiently evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

Iwamuro

Okada²,

Takata³

et al. 2012

WJG

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AIM:To investigate the capacity for 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) to evaluate patients with gastrointestinal lesions of follicular lymphoma. METHODS:This retrospective case series consisted of 41 patients with follicular lymphoma and gastrointestinal involvement who underwent 18F-FDG-PET and endoscopic evaluations at ten different institutions between November 1996 and October 2011. Data for endoscopic, radiological, and biological examinations performed were retrospectively reviewed from clinical records. A semi-quantitative analysis of 18F-FDG uptake was performed for each involved area by calculating the maximum standardized uptake value (SUVmax). Based on the positivity of 18F-FDG uptake in the gastrointestinal lesions analyzed, patients were subdivided into two groups. To identify potential predictive factors for 18F-FDG positivity, these two groups were compared with respect to gender, age at diagnosis of lymphoma, histopathological grade, pattern of follicular dendritic cells, mitotic rate, clinical stage, soluble interleukin-2 receptor levels detected by 18F-FDG-PET, lactate dehydrogenase (LDH) levels, hemoglobin levels, bone marrow involvement, detectability of gastrointestinal lesions by computed tomography (CT) scanning, and follicular lymphoma international prognostic index (FLIPI) risk. ORIGINAL ARTICLE RESULTS:Involvement of follicular lymphoma in the stomach, duodenum, jejunum, ileum, cecum, colon, and rectum was identified in 1, 34, 6, 3, 2, 3, and 6 patients, respectively. No patient had esophageal involvement. In total, 19/41 (46.3%) patients exhibited true-positive 18F-FDG uptake in the lesions present in their gastrointestinal tract. In contrast, false-negative 18F-FDG uptake was detected in 24 patients (58.5%), while false-positive 18F-FDG uptake was detected in 5 patients (12.2%). In the former case, 2/19 patients had both 18F-FDG-positive lesions and 18F-FDGnegative lesions in the gastrointestinal tract. In patients with 18F-FDG avidity, the SUVmax value of the involved gastrointestinal tract ranged from 2.6 to 17.4 (median: 4.7). For the 18F-FDG-negative (n = 22) and -positive (n = 19) groups, there were no differences in the male to female ratios (10/12 vs 4/15, P = 0.186), patient age (63.6 ± 2.4 years vs 60.1 ± 2.6 years, P = 0.323), presence of histopathological grade 1 vs 2 (20/2 and 17/2, P = 1.000), follicular dendritic cell pattern (duodenal/nodal: 13/5 vs 10/3, P = 1.000), mitotic rate (low/ partly high, 14/1 vs 10/3, P = 0.311), clinical stage according to the Ann Arbor system (stages ⅠE and ⅡE/ other, 15/7 vs 15/4, P = 0.499), clinical stage according to the Lugano system (stages Ⅰ and Ⅱ-1/other, 14/8 vs 14/5, P = 0.489), soluble interleukin-2 receptor levels (495 ± 78 vs 402 ± 83, P = 0.884), LDH levels (188 ± 7 vs 183 ± 8, P = 0.749), hemoglobin levels (13.5 ± 0.3 vs 12.8 ± 0.4, P = 0.197), bone marrow involvement (positive/negative, 1/8 vs 1/10, P = 1.000), detectability by CT scanning (positive/negative, 1/16 vs 4/13, P = 0.335...

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

Iwamuro

Okada²,

Takata³

et al. 2012

WJG

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“…In recent studies that evaluated an extensive area of the small intestine by DBE, involvement of the jejunum and/or the ileum was identified in 80% to 100% of patients. [5][6][7][8][9] In our current study, jejunoileal lesions were found identified in 90% of the patients who underwent DBE or SBE. In addition, gastric involvement was relatively frequent in our study (29%), in contrast to previous studies, in which the frequency ranged from only 0% to 26%.…”

Section: Discussionmentioning

confidence: 84%

“…Lymphomatous polyposis, which implies that there are multiple, whitish, small, sessile polyps or nodules, is considered 1 of the most characteristic macroscopic findings of intestinal FL. [3][4][5][6][7][14][15][16] An optimal therapeutic strategy for gastrointestinal FL has not been established. Various treatments, including watchful waiting, surgery, chemotherapy, radiotherapy, immunotherapy (rituximab), or a combination of these, have been applied to patients with FL.…”

Section: Discussionmentioning

confidence: 99%

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Translocation t(14;18)/IGH‐BCL2 in gastrointestinal follicular lymphoma

Yanai

Nakamura

Takeshita

et al. 2010

Cancer

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BACKGROUND: Chromosomal translocation t(14;18)(q32;q21) involving the immunoglobulin heavy chain gene (IGH) and the BCL2 gene (t[14;18][q32;q21]/IGH-BCL2) is present in 60% to 90% of nodal follicular lymphomas. To the authors' knowledge, the prevalence and clinical significance of this translocation have not been examined previously in gastrointestinal follicular lymphomas. METHODS: Clinicopathologic and molecular features were investigated in 48 patients who had gastrointestinal follicular lymphoma. The site of involvement was the duodenum in 54% of patients, the jejunum in 52%, the ileum in 52%, the stomach in 29%, and the colorectum in 15%. The presence of the t(14;18)/ IGH-BCL2 translocation was detected by interphase fluorescence in situ hybridization. RESULTS: Treatment modalities included surgical resection (n ¼ 16), rituximab plus chemotherapy (n ¼ 13), rituximab alone (n ¼ 6), antibiotics (n ¼ 5), and watchful waiting (n ¼ 8). Complete remission (CR) of lymphoma was achieved in 31 patients (65%). The overall survival and event-free survival rates after 5 years were 93% and 68%, respectively. The t(14;18)/IGH-BCL2 was detected in 39 patients (81%). The involvement of multiple sites (69% vs 0%), manifestation of the lymphomatous polyposis type (72% vs 22%), and histologic grade 1 or 2 tumors (92% vs 56%) were more frequent in the t(14;18)-positive group than in the negative group. In addition, the CR rate was lower in the t(14;18)-positive group than in the negative group (56% vs 100%; P ¼.0179), and a trend was observed toward poorer event-free survival in the positive group (P ¼.089). CONCLUSIONS: The t(14;18)/IGH-BCL2 chromosomal translocation occurred frequently in gastrointestinal follicular lymphomas. The current results indicated that this translocation may be a predictor of an adverse clinical course.

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Gastrointestinal follicular lymphoma: using primary site as a predictor of survival

et al. 2016

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Gastrointestinal follicular lymphoma (GI‐FL) is a rare extranodal variant of follicular lymphoma (FL) that has been increasingly reported in the literature. An especially indolent course is linked to the disease after a lack of observed patient death in past studies. However, overall survival (OS) and associated prognostic factors remain unclear. A large population‐based database was utilized to identify demographic and clinicopathologic characteristics of GI‐FL, along with survival differences among primary sites. The Surveillance, Epidemiology, and End Results Registry was used to identify GI‐FL cases between the years of 1973 and 2012. Kaplan–Meier curves compared OS differences and Cox proportional hazard models analyzed prognostic factors. Final analysis included 1109 cases. Small intestinal cases, which included those with single‐site and multi‐segment involvement, were most common (63.6%) followed by gastric (18.2%) and colorectal cases (18.2%). Small intestinal GI‐FL presented more frequently with grade I histology, and less often with grade III histology (P < 0.001 and P < 0.001, respectively). Small intestinal cases had better outcomes (5‐year OS = 80.9%, P < 0.001) compared to cases involving the stomach (5‐year OS = 52.7%) and colorectum (5‐year OS = 71.5%). On multivariate analysis for predictors of mortality, small intestinal involvement predicted for better survival; hazard ratio (HR) 0.66 (95% CI: 0.51–0.85). Advanced age (≥66), grade (grade III), and stage (Ann Arbor Stage III/IV) predicted for mortality with HR 5.46 (95% CI: 3.80–7.84), 1.42 (95% CI: 1.10–1.83), 1.57 (95% CI: 1.15–2.16), respectively. GI‐FL has poorer outcomes than previously suggested. Small intestinal involvement has a better prognosis. A possible biological basis for this will require further investigations in the future.

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Impact of double-balloon endoscopy on the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas: a case series

Cited by 33 publications

References 14 publications

Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

Translocation t(14;18)/IGH‐BCL2 in gastrointestinal follicular lymphoma

Gastrointestinal follicular lymphoma: using primary site as a predictor of survival

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