Primary follicular lymphoma of the gastrointestinal tract: a retrospective case series

Kodama, Motomu; Kitadai, Yasuhiko; Shishido, Tadayuki; Shimamoto, Masato; Fukumoto, Atsushi; Masuda, Hideaki; Tanaka, Shouichi; Yoshihara, Masaharu; Sakai, Azusa; Nakayama, H.; Chayama, Kazuaki

doi:10.1055/s-2007-995365

Cited by 42 publications

(47 citation statements)

References 10 publications

(10 reference statements)

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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: 93%

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: 93%

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: Discussionsupporting

confidence: 50%

“…Various treatments, including watchful waiting, surgery, chemotherapy, radiotherapy, immunotherapy (rituximab), or a combination of these, have been applied to patients with FL. In 2 reports by Kodama et al 6 and Akamatsu et al, 9 all of the patients who received R-CHOP therapy achieved CR, and the investigators emphasized the efficacy of immunochemotherapy for gastrointestinal FL. In contrast, Damaj et al 15 and Mori et al 17 reported that the prognosis (which they assessed as the median time to PD 15 or progression-free survival 17 ) did not differ between patients who received a certain antitumor treatment and who received no treatment (watchful waiting).…”

Section: Discussionmentioning

confidence: 99%

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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“…Although the duodenal second portion is the most frequent site of FL in the gastrointestinal tract, 3,4 it sometimes occurs primarily in the gastrointestinal tract outside of the duodenum. Using double-balloon and/or capsule endoscopy, FLs of the gastrointestinal tract primarily involve the duodenum and frequently spread to the small intestine, 3 Few FLs occur in the stomach and colon, but the clinicopathological features of FL in such organs remain unclear.…”

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confidence: 99%

“…Using double-balloon and/or capsule endoscopy, FLs of the gastrointestinal tract primarily involve the duodenum and frequently spread to the small intestine, 3 Few FLs occur in the stomach and colon, but the clinicopathological features of FL in such organs remain unclear. AID has a key role in class switching and somatic hypermutation in B cells, 5 and BACH2 also has a role in these processes in B cells.…”

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confidence: 99%

Duodenal follicular lymphoma lacks AID but expresses BACH2 and has memory B-cell characteristics

et al. 2013

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We have reported previously that duodenal follicular lymphoma (FL) is distinct from nodal FL and showed more resemblance to mucosa-associated lymphoid tissue lymphoma, and that FL frequently involved the duodenal second portion. In the present study, we examined duodenal FLs and gastric/colonic FLs to clarify the clinicopathological and immunological differences between the tumor types. We analyzed 8 samples of gastric FL, 17 of duodenal ones, and 5 of colonic/rectal ones, and characterized them by immunohistochemistry, immunogenotyping, and histology. Gastric and colonic FLs presented in submucosal to subserosal areas, whereas duodenal ones presented in the mucosal to submucosal layers. Immunohistochemical analysis revealed that duodenal FLs exhibited the following phenotypes:and loose CD21 network (duodenal pattern). Gastric/colonic FLs exhibited the following phenotypes:, and a dense CD21 network (nodal pattern). Expression of AID and CD27 in lymphoma cells and the CD21 network pattern were considerably different between duodenal FLs and gastric/colonic ones. Moreover, in situ hybridization revealed that, in the duodenal FLs, BACH2 was expressed at the periphery of the tumor follicle and tumor villi. The number of immunoglobulin heavy-chain variable domains VH4 and VH5 were higher in duodenal follicular lymphomoas than in gastric FLs. The lymphoma cells of duodenal FLs are different from those of gastric/ colonic FLs, and duodenal FL is distinct even within the gastrointestinal tract. Somatic hypermutation in immunoglobulin genes and CD27 expression are hallmarks of memory B cells. We suggest that duodenal FL cells are in the memory B-cell stage, and require BACH2 instead of AID for ongoing mutation.

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Primary follicular lymphoma of the gastrointestinal tract: a retrospective case series

Cited by 42 publications

References 10 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

Duodenal follicular lymphoma lacks AID but expresses BACH2 and has memory B-cell characteristics

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