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Primary follicular lymphoma of the duodenum with erosions as atypical macroscopic features.

Takeuchi K, Iwamuro M, Imagawa A, Kubota Y, Miyatani K, Takata K, Okada H - Case Rep Med (2012)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kan'onji 769-1695, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

Histological findings of the biopsy samples. The initial biopsy specimens taken from the border of erosions contained small number of duodenal villi. Lymphoma cells were scanty, and therefore, the specimens were inadequate for pathological diagnosis ((a) hematoxylin and eosin staining, original magnification ×40). Second biopsy specimens taken from the peripheral whitish mucosa showed lymphoid follicles composed of small-to-medium-sized lymphoid cells ((b) hematoxylin and eosin staining, original magnification ×40). Lymphoma cells also infiltrated into the duodenal villi ((c) hematoxylin and eosin staining, original magnification ×200). Lymphoma cells were positive for CD10 ((d) original magnification ×40) and BCL2 staining ((e) original magnification ×40).
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fig2: Histological findings of the biopsy samples. The initial biopsy specimens taken from the border of erosions contained small number of duodenal villi. Lymphoma cells were scanty, and therefore, the specimens were inadequate for pathological diagnosis ((a) hematoxylin and eosin staining, original magnification ×40). Second biopsy specimens taken from the peripheral whitish mucosa showed lymphoid follicles composed of small-to-medium-sized lymphoid cells ((b) hematoxylin and eosin staining, original magnification ×40). Lymphoma cells also infiltrated into the duodenal villi ((c) hematoxylin and eosin staining, original magnification ×200). Lymphoma cells were positive for CD10 ((d) original magnification ×40) and BCL2 staining ((e) original magnification ×40).

Mentions: Esophagogastroduodenoscopy revealed irregular-shaped erosions aboral to the ampulla of Vater (Figure 1). The mucosa around the erosions appeared edematous and was composed of whitish enlarged villi. The lesions were soft and thus were easily deformed by deaeration. Two biopsy samples were taken from the erosions, and one sample was taken from the border of the erosions. These samples contained small-to-medium-sized lymphoid cells, but the number of lymphoid cells was not enough to make a definitive diagnosis of any type of lymphoma (Figure 2(a)). Esophagogastroduodenoscopy was then repeated, and biopsy specimens were taken from the whitish villi around the duodenal erosions. The specimen contained lymphoid follicles in the duodenal mucosa, and these were comprised of small-to-medium-sized lymphoid cells, which had also infiltrated into the villi (Figures 2(b) and 2(c)). The lymphoid cells were positive for CD20, CD10 (Figure 2(d)), and BCL2 (Figure 2(e)), but negative for CD3. Colonoscopy revealed no abnormality. Evaluation of small bowel involvement by double-balloon enteroscopy or video capsule endoscopy was proposed but was not performed as the patient refused. Computed tomography (CT) scanning of the neck, chest, abdomen, and pelvis showed neither lymphadenopathy nor a thickened gastrointestinal wall including the duodenum. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning detected positive tracer uptake in the inferior duodenal angle, whereas in other organs there were no abnormal accumulations of 18F-FDG (Figure 3). Consequently, the patient was diagnosed with primary follicular lymphoma of the duodenum. The clinical stage was considered as stage I, based on the Lugano staging system for the classification of the gastrointestinal tract lymphoma [6, 7] (stage I: confined to the gastrointestinal tract, stage II-1: extending into the abdomen from primary gastrointestinal site with local nodal involvement, stage II-2: extending into the abdomen from primary gastrointestinal site with distant nodal involvement, stage IV: disseminated extranodal involvement or concomitant supradiaphragmatic nodal involvement).


Primary follicular lymphoma of the duodenum with erosions as atypical macroscopic features.

Takeuchi K, Iwamuro M, Imagawa A, Kubota Y, Miyatani K, Takata K, Okada H - Case Rep Med (2012)

Histological findings of the biopsy samples. The initial biopsy specimens taken from the border of erosions contained small number of duodenal villi. Lymphoma cells were scanty, and therefore, the specimens were inadequate for pathological diagnosis ((a) hematoxylin and eosin staining, original magnification ×40). Second biopsy specimens taken from the peripheral whitish mucosa showed lymphoid follicles composed of small-to-medium-sized lymphoid cells ((b) hematoxylin and eosin staining, original magnification ×40). Lymphoma cells also infiltrated into the duodenal villi ((c) hematoxylin and eosin staining, original magnification ×200). Lymphoma cells were positive for CD10 ((d) original magnification ×40) and BCL2 staining ((e) original magnification ×40).
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fig2: Histological findings of the biopsy samples. The initial biopsy specimens taken from the border of erosions contained small number of duodenal villi. Lymphoma cells were scanty, and therefore, the specimens were inadequate for pathological diagnosis ((a) hematoxylin and eosin staining, original magnification ×40). Second biopsy specimens taken from the peripheral whitish mucosa showed lymphoid follicles composed of small-to-medium-sized lymphoid cells ((b) hematoxylin and eosin staining, original magnification ×40). Lymphoma cells also infiltrated into the duodenal villi ((c) hematoxylin and eosin staining, original magnification ×200). Lymphoma cells were positive for CD10 ((d) original magnification ×40) and BCL2 staining ((e) original magnification ×40).
Mentions: Esophagogastroduodenoscopy revealed irregular-shaped erosions aboral to the ampulla of Vater (Figure 1). The mucosa around the erosions appeared edematous and was composed of whitish enlarged villi. The lesions were soft and thus were easily deformed by deaeration. Two biopsy samples were taken from the erosions, and one sample was taken from the border of the erosions. These samples contained small-to-medium-sized lymphoid cells, but the number of lymphoid cells was not enough to make a definitive diagnosis of any type of lymphoma (Figure 2(a)). Esophagogastroduodenoscopy was then repeated, and biopsy specimens were taken from the whitish villi around the duodenal erosions. The specimen contained lymphoid follicles in the duodenal mucosa, and these were comprised of small-to-medium-sized lymphoid cells, which had also infiltrated into the villi (Figures 2(b) and 2(c)). The lymphoid cells were positive for CD20, CD10 (Figure 2(d)), and BCL2 (Figure 2(e)), but negative for CD3. Colonoscopy revealed no abnormality. Evaluation of small bowel involvement by double-balloon enteroscopy or video capsule endoscopy was proposed but was not performed as the patient refused. Computed tomography (CT) scanning of the neck, chest, abdomen, and pelvis showed neither lymphadenopathy nor a thickened gastrointestinal wall including the duodenum. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning detected positive tracer uptake in the inferior duodenal angle, whereas in other organs there were no abnormal accumulations of 18F-FDG (Figure 3). Consequently, the patient was diagnosed with primary follicular lymphoma of the duodenum. The clinical stage was considered as stage I, based on the Lugano staging system for the classification of the gastrointestinal tract lymphoma [6, 7] (stage I: confined to the gastrointestinal tract, stage II-1: extending into the abdomen from primary gastrointestinal site with local nodal involvement, stage II-2: extending into the abdomen from primary gastrointestinal site with distant nodal involvement, stage IV: disseminated extranodal involvement or concomitant supradiaphragmatic nodal involvement).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Mitoyo General Hospital, Kan'onji 769-1695, Japan.

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.

No MeSH data available.


Related in: MedlinePlus