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Gjeorgjievski M, Makki I, Khanal P, Amin MB, Blenc AM, Desai T, Cappell MS. Early, Isolated Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma Presenting without Symptoms or Grossly Apparent Endoscopic Lesions and Diagnosed by Random Duodenal Biopsies. Case Rep Gastroenterol 2016; 10:323-31. [PMID: 27482191 PMCID: PMC4945810 DOI: 10.1159/000447293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
Clinical data regarding mucosa-associated lymphoid tissue lymphoma (MALToma) solely involving the duodenum are sparse because of the relative rarity of the disease. A comprehensive literature review revealed only 17 cases reported until 2004, and only a moderate number of cases have been reported since. MALToma can be asymptomatic in its very early stages but frequently produces localized or nonspecific symptoms, including early satiety, abdominal pain, vomiting, and involuntary weight loss in later stages. While gastric MALToma is strongly associated with gastric Helicobactor pylori infection, duodenal MALToma is often unassociated with H. pylori infection. A 74-year-old female presented with only dysphagia (without symptoms referable to a duodenal lesion), without systemic 'B' symptoms, and with no evident duodenal lesions at esophagogastroduodenoscopy; however, she was diagnosed with duodenal MALToma by pathologic examination of random duodenal biopsies performed to exclude celiac disease. An important clinical feature of this case is that duodenal MALToma was diagnosed by pathologic analysis of duodenal biopsies despite (1) no endoscopically apparent duodenal lesions; (2) duodenal involvement without gastric involvement; (3) lack of symptoms attributable to duodenal MALToma, and (4) absence of evident H. pylori infection. This work shows that early duodenal MALToma can be difficult to diagnose because of absent symptoms, absence of gastric involvement, absence of endoscopic abnormalities, and absence of H. pylori infection; it may require random duodenal biopsies for diagnosis.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich., USA
| | - Issa Makki
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich., USA
| | - Pradeep Khanal
- Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich., USA
| | - Mitual B Amin
- Department of Pathology, William Beaumont Hospital, Royal Oak, Mich., USA
| | - Ann Marie Blenc
- Department of Pathology, Oakland University William Beaumont School of Medicine, Royal Oak, Mich., USA
| | - Tusar Desai
- Division of Gastroenterology and Hepatology, Oakland University William Beaumont Hospital, Royal Oak, Mich., USA
| | - Mitchell S Cappell
- Division of Gastroenterology, Oakland University William Beaumont School of Medicine, Royal Oak, Mich., USA
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Carman R, Snyder J, Davidson M. Primary mucosa-associated lymphoid tumor lymphoma of the duodenum: a rare presentation of non-Hodgkin's lymphoma. J Clin Oncol 2011; 29:e226-9. [PMID: 21205760 DOI: 10.1200/jco.2010.31.9525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Duodenal MALT Lymphoma Presenting With Obstructive Jaundice: Report of a Case and Review of the Literature. J Gastrointest Cancer 2008; 38:28-31. [DOI: 10.1007/s12029-008-9012-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
We conducted a retrospective tumor registry review of a 36-year experience in a university center and identified 10 patients with duodenal lymphoma (five localized, five disseminated). Histologic types included diffuse large B-cell in four patients, mucosa-associated lymphoid tumor in three, and Hodgkin, follicular, and unclassified (one each). Treatments included chemotherapy in four patients, radiation therapy (RT) in two patients, Helicobacter pylori treatment in two, and observation in one. Five patients underwent operations (emergent in two, elective in three) for indications including massive bleeding in two patients, obstruction in two, or both in one. Survival for surgical group was 25 per cent at 1 year. One-year survival for nonsurgical group was 100 per cent, and all nonoperated patients lived at least 5 years, except for one who is alive 2 years after diagnosis. Surgical patients were younger and had more advanced lesions and less favorable cell types. When operation is required for bleeding or obstruction from secondary tumors in younger patients with disseminated disease, surgical challenges are formidable and survival is very limited. Tumors of less aggressive histology have far better prognosis.
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Affiliation(s)
- Paul J. Chestovich
- Division of General Surgery, Department of Surgery, the, Los Angeles, California
| | - Gary Schiller
- Division of Hematology–Oncology, Department of Medicine, and the, Los Angeles, California
| | - Sebastian Sasu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan R. Hiatt
- Division of General Surgery, Department of Surgery, the, Los Angeles, California
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Azar C, Soweid A, Berro Z, Salem ZMK, Geara FB, Kattar MM, Hashash JG, Barada KA. Duodenal mucosa-associated lymphoid tissue lymphoma successfully treated by radiation therapy. ACTA ACUST UNITED AC 2007; 7:428-31. [PMID: 17621410 DOI: 10.3816/clm.2007.n.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is very rare, and little is known about its clinical characteristics, endoscopic and endosonographic features, and treatment. We hereby report a case of duodenal MALT lymphoma successfully treated by radiation therapy (RT). The patient was referred to us with epigastric pain and positive fecal occult blood testing. His symptoms failed to resolve with eradication therapy for a Helicobacter pylori infection that was diagnosed by a gastric biopsy performed elsewhere. Endoscopy at our institution revealed hypertrophy of the duodenal folds with erosions involving a third of the circumference few centimeters beyond the ampulla of Vater. Histopathologic and immunophenotypic features were consistent with a MALT lymphoma. There was no evidence of a H. pylori infection by gastric biopsy and urea breath test. Computed tomography scan of the abdomen and pelvis was normal. Endoscopic ultrasound showed thickening of the duodenal wall and hypoechoic infiltration into the submucosal layer. The patient was treated with RT with a complete response. Two and a half years later, he remains in complete clinical, endoscopic, and histopathologic remission. This case illustrates the importance of RT in patients with duodenal MALT lymphoma whose disease did not respond to H. pylori eradication.
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Affiliation(s)
- Cecilio Azar
- Department of Internal Medicine, American University of Beirut Medical Center, Hamra Street, Beirut 110, 32090 Lebanon
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Narváez JA, Domingo-Domènech E, Roca Y, Romagosa V, De Lama E, González-Barca E, Petit J, Fernández-Sevilla A. Radiological features of non-gastric mucosa-associated lymphoid tissue lymphomas. Curr Probl Diagn Radiol 2005; 33:212-25. [PMID: 15459631 DOI: 10.1067/j.cpradiol.2004.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- José Antonio Narváez
- Department of CT and MR Imaging, Institut de Diagnòstic per la Imatge,Hospital Duran i Reynals, Barcelona, Spain
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Isomoto H, Kamihira S, Matsuo E, Tawara M, Mizuta Y, Hayashi T, Maeda T, Kohno S, Tomonaga M. A case of mucosa-associated lymphoid tissue lymphoma of the ampulla of Vater: successful treatment with radiation therapy. Eur J Gastroenterol Hepatol 2003; 15:1037-41. [PMID: 12923379 DOI: 10.1097/00042737-200309000-00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma of the papilla of Vater is rare, and little is known of either its association with Helicobacter pylori infection or the optimal treatment modalities. We describe the first case of MALT lymphoma involving the major papilla that remained unchanged despite eradication of H. pylori, but which regressed following radiotherapy. A 46-year-old asymptomatic man was admitted to hospital for treatment of MALT lymphoma involving the papilla of Vater. Duodenal endoscopy showed multiple granules around the major ampulla, and biopsies revealed mucosal proliferation of centrocyte-like cells, lymphoepithelial lesions, hyperplastic lymphoid follicles and plasmacytic differentiation. The lymphoma cells were positive for B-cell but negative for T-cell markers, and expressed Bcl-2 but showed no immunoreactivity for CD5, CD10 and cyclin D, consistent with MALT lymphoma. The patient was successfully treated with triple therapy of lansoprazole, amoxicillin and clarithromycin for 1 week for coexisting H. pylori infection in the stomach, but the lymphoma lesions remained unchanged. Then, involved-field irradiation was applied at a total dose of 30 Gy delivered in 1.5 Gy fractions without any adverse events. Six months later, repeat endoscopy revealed disappearance of the granular lesions and lack of lymphoma cells in biopsy specimens. Four years after the commencement of radiotherapy, the patient is still in complete remission. Radiotherapy seems a safe and effective treatment modality for low-grade MALT lymphoma of the ampulla of Vater.
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Affiliation(s)
- Hajime Isomoto
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Sakamoto, Nagasaki, Japan.
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Leone N, Brunello F, Baronio M, Giordanino C, Morgando A, Marchesa P, Delsedime L, Rizzetto M. High-grade B-cell lymphoma arising in mucosa-associated lymphoid tissue of the duodenum. Eur J Gastroenterol Hepatol 2002; 14:893-6. [PMID: 12172414 DOI: 10.1097/00042737-200208000-00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Duodenal mucosa-associated lymphoid tissue lymphoma is a rare neoplasm. We report a case of a 70-year-old man with non-Hodgkin's lymphoma located in the descending duodenum that was not associated with Helicobacter pylori infection of the stomach. A surgical resection due to obstruction of the bowel lumen above the ligament of Treitz was performed. No invasion into the adjacent structure was confirmed at surgery. The pathological examination showed an infiltration of the duodenal mucosa and submucosa with B lymphocytes. Monoclonal proliferation of the lymphoid tissue was demonstrated by polymerase chain reaction. The histological appearance and the demonstration of monoclonality fulfilled the criteria for malignant high-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue.
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MESH Headings
- Aged
- Biopsy, Needle
- Duodenal Neoplasms/diagnosis
- Duodenal Neoplasms/pathology
- Duodenal Neoplasms/surgery
- Duodenoscopy
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Intestinal Mucosa/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/surgery
- Male
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography
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Affiliation(s)
- Nicola Leone
- Department of Gastroenterology, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy.
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Nakamura S, Matsumoto T, Nakamura S, Kusano Y, Esaki M, Kurahara K, Fukuda T. Duodenal mucosa-associated lymphoid tissue lymphoma treated by eradication of Helicobacter pylori: report of 2 cases including EUS findings. Gastrointest Endosc 2001; 54:772-5. [PMID: 11726860 DOI: 10.1067/mge.2001.119602] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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