Primary Follicular Lymphoma of the Duodenum with Erosions as Atypical Macroscopic Features

Abstract

A 52-year-old Japanese woman who was eventually diagnosed with primary follicular lymphoma of the duodenum showed atypical endoscopic features, namely, erosions with peripheral whitish edematous mucosa. Initial biopsy specimens taken from the erosions revealed insufficient numbers of lymphoma cells for histological diagnosis. Subsequent biopsy specimens from the peripheral mucosa containing the whitish enlarged villi showed infiltration of the lymphoma cells forming lymphoid follicles, which led us to the appropriate diagnosis. This case indicates that endoscopists should take biopsy samples from the peripheral mucosa with whitish enlarged villi rather than erosions in the rare instances that erosions appear as the main macroscopic feature of intestinal follicular lymphoma.

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

“…For the other two patients, one presented with erosions having peripheral whitish mucosa in the duodenum, while the other had confluent whitish granules in the duodenum. These atypical macroscopic features were previously described [44,45] . Jejunal involvement was identified in six patients.…”

“…It is well-known that follicular lymphoma often affects multiple gastrointestinal tracts. 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] .…”

Primary Gastrointestinal Follicular Lymphomas: A Prospective Study of 31 Patients with Long-term Follow-up Registered in the French Gastrointestinal Lymphoma Study Group (GELD) of the French Federation of Digestive Oncology (FFCD)

“…Primary gastrointestinal follicular lymphomas (PGFL) represent a very rare entity, whose frequency in different clinicopathological series of primary gastrointestinal lymphomas varied from 3% to 13%. [1][2][3][4] The clinical and biological characteristics of these Primary Gastrointestinal Follicular Lymphomas: A Prospective Study of 31 Patients with Long-term Follow-up Registered in the French Gastrointestinal Lymphoma Study Group (GELD) of the French Federation of Digestive Oncology (FFCD) lymphomas are not well known, and have been described mainly through clinical cases [5][6][7][8][9] and some clinicopathological series, usually retrospective, reported in the literature. [10][11][12][13][14][15][16][17][18] Due to their rarity and lack of randomized trials, the treatment of PGFL is not standardized.…”

Magnifying Endoscopic Observation of Duodenal Involvement of Follicular Lymphoma before and after Chemotherapy

“…Generally once complete remission is obtained, duodenal lesions disappear and restoration to intact mucosa is achieved. Endoscopic pictures showing such a recovery of duodenal mucosa after CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) (14), CHOP plus rituximab (3), or radiotherapy (15,16) have been presented in previous reports. Moreover, a spontaneous disappearance of duodenal lesions in two cases has been described (10).…”