1
|
Alnughmush A, Fakih RE, Alyamany R, Bakshi N, Alhayli S, Aljurf M. Duodenal-type follicular lymphoma: comprehensive insights into disease characteristics and established treatment strategies. Curr Opin Oncol 2024:00001622-990000000-00206. [PMID: 39246163 DOI: 10.1097/cco.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
PURPOSE OF REVIEW This review aims to detail the characteristics and outcomes of duodenal-type follicular lymphoma (DTFL), a rare lymphoma variant. It focuses on integrating recent reports in treatment modalities and highlights emerging insights into the unique biological features of the disease. RECENT FINDING Recent studies confirm the indolent nature of DTFL, with extended follow-up periods showing favorable outcomes under watchful waiting strategies and a notable proportion of patients experiencing spontaneous remission. Additionally, advancements in understanding the disease's biology revealed that the tumor microenvironment is marked by specific genomic expressions indicative of chronic inflammation. SUMMARY The observations of spontaneous resolution and the generally favorable progression of DTFL call for a conservative approach in initiating treatment. Clinical management should judiciously consider the disease's typically benign course against the potential risks of intervention, promoting customized treatment protocols tailored for cases with clinical necessity. Additionally, the discovery of an inflammatory tumor microenvironment and molecular evidence suggesting an antigen-driven process highlight critical areas for future research.
Collapse
Affiliation(s)
- Ahmed Alnughmush
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre
| | - Riad El Fakih
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre
| | - Ruah Alyamany
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre
| | - Nasir Bakshi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Saud Alhayli
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre
| | - Mahmoud Aljurf
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre
| |
Collapse
|
2
|
Mauro AJ, Bell PD, McGrath K. Gastrointestinal Follicular Lymphoma of the Cecum Treated via Endoscopic Full-Thickness Resection. ACG Case Rep J 2024; 11:e01466. [PMID: 39176216 PMCID: PMC11340927 DOI: 10.14309/crj.0000000000001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/04/2024] [Accepted: 07/11/2024] [Indexed: 08/24/2024] Open
Abstract
Gastrointestinal follicular lymphoma (GI-FL) is an uncommon non-Hodgkin lymphoma that affects the gastrointestinal tract. It typically occurs within the duodenum with the appearance of multiple nodules. Treatment options, depending on stage and grade of the tumor, include aggressive chemotherapy, immunotherapy, radiotherapy, surgical or endoscopic resection, or simply monitoring as focal disease may be indolent. We present a rare case of a GI-FL presenting as a solitary lesion within the cecum treated via endoscopic full-thickness resection using the Ovesco full-thickness resection device. This case demonstrates the effectiveness of endoscopic full-thickness resection in treating small GI-FL in the colon.
Collapse
Affiliation(s)
| | - Phoenix D. Bell
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - Kevin McGrath
- Division of Gastroenterology, Hepatology, & Nutrition, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
3
|
Li X, Gao F, Meng X, Zhang X, Sun C, Liu H, Yu J, Liu X, Han X, Li L, Qiu L, Qian Z, Zhou S, Gong W, Golchehre Z, Chavoshzadeh Z, Ren X, Wang X, Zhang H. Epidemiological features and prognosis for primary gastrointestinal follicular lymphoma. Br J Haematol 2024; 204:1771-1779. [PMID: 38447995 DOI: 10.1111/bjh.19393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
Primary gastrointestinal follicular lymphoma (PGI-FL) is a rare extra-nodal lymphoma. Its epidemiology and prognosis remain unclear. We performed a retrospective analysis of eligible patients with 1648 PGI-FL and 34 892 nodal FL (N-FL) in the Surveillance, Epidemiology and End Results (SEER) database. The age-adjusted average annual incidence of PGI-FL was 0.111/100000. The median overall survival (OS) for PGI-FL and N-FL patients was 207 and 165 months respectively. The 5-year diffuse large B-cell lymphoma (DLBCL) transformation rates were 2.1% and 2.6% respectively. Age, sex, grade, Ann Arbor stage, primary site and radiation were independent prognostic factors (p < 0.05). Nomograms were constructed to predict 1-, 5- and 10-year OS and disease-specific survival (DSS). The receiver operating characteristic curves and calibration plots showed the established nomograms had robust and accurate performance. Patients were classified into three risk groups according to nomogram score. In conclusion, the incidence of PGI-FL has increased over the past 40 years, and PGI-FL has a better prognosis and a lower DLBCL transformation rate than N-FL. The nomograms were developed and validated as an individualized tool to predict survival. Patients were divided into three risk groups to assist clinicians in identifying high-risk patients and choosing the optimal individualized treatments.
Collapse
MESH Headings
- Humans
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/therapy
- Lymphoma, Follicular/diagnosis
- Female
- Male
- Middle Aged
- Aged
- Gastrointestinal Neoplasms/epidemiology
- Gastrointestinal Neoplasms/mortality
- Gastrointestinal Neoplasms/diagnosis
- Gastrointestinal Neoplasms/therapy
- Adult
- Retrospective Studies
- Prognosis
- SEER Program
- Aged, 80 and over
- Nomograms
- Incidence
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Adolescent
- Young Adult
Collapse
Affiliation(s)
- Xuelei Li
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Fenghua Gao
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xiangrui Meng
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xiaoyan Zhang
- State Key Laboratory of Experimental Hematology and Division of Pediatric Blood Diseases Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Tianjin, China
| | - Cong Sun
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Hengqi Liu
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Jingwei Yu
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xia Liu
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xue Han
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Lanfang Li
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Lihua Qiu
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Zhengzi Qian
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Shiyong Zhou
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Wenchen Gong
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zahra Golchehre
- Department of Medical Genetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Chavoshzadeh
- Department of Immunology/Allergy, Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Xiubao Ren
- Department of Immunology/Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xianhuo Wang
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Huilai Zhang
- Department of Lymphoma and National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| |
Collapse
|
4
|
Watanabe T. Gene targeted and immune therapies for nodal and gastrointestinal follicular lymphomas. World J Gastroenterol 2023; 29:6179-6197. [PMID: 38186866 PMCID: PMC10768399 DOI: 10.3748/wjg.v29.i48.6179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023] Open
Abstract
Follicular lymphoma (FL) is the most common indolent B-cell lymphoma (BCL) globally. Recently, its incidence has increased in Europe, the United States, and Asia, with the number of gastrointestinal FL cases expected to increase. Genetic abnormalities related to t(14;18) translocation, BCL2 overexpression, NF-κB pathway-related factors, histone acetylases, and histone methyltransferases cause FL and enhance its proliferation. Meanwhile, microRNAs are commonly used in diagnosing FL and predicting patient prognosis. Many clinical trials on novel therapeutics targeting these genetic abnormalities and immunomodulatory mechanisms have been conducted, resulting in a marked improvement in therapeutic outcomes for FL. Although developing these innovative therapeutic agents targeting specific genetic mutations and immune pathways has provided hope for curative options, FL treatment has become more complex, requiring combinatorial therapeutic regimens. However, optimal treatment combinations have not yet been achieved, highlighting the importance of a complete under-standing regarding the pathogenesis of gastrointestinal FL. Accordingly, this article reviews key research on the molecular pathogenesis of nodal FL and novel therapies targeting the causative genetic mutations. Moreover, the results of clinical trials are summarized, with a particular focus on treating nodal and gastrointestinal FLs.
Collapse
Affiliation(s)
- Takuya Watanabe
- Department of Internal Medicine and Gastroenterology, Watanabe Internal Medicine Aoyama Clinic, Niigata 9502002, Japan
| |
Collapse
|
5
|
Sumioka A, Tsuboi A, Oka S, Kato Y, Matsubara Y, Hirata I, Takigawa H, Yuge R, Shimamoto F, Tada T, Tanaka S. Disease surveillance evaluation of primary small-bowel follicular lymphoma using capsule endoscopy images based on a deep convolutional neural network (with video). Gastrointest Endosc 2023; 98:968-976.e3. [PMID: 37482106 DOI: 10.1016/j.gie.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/01/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND AIMS Capsule endoscopy (CE) is useful in evaluating disease surveillance for primary small-bowel follicular lymphoma (FL), but some cases are difficult to evaluate objectively. This study evaluated the usefulness of a deep convolutional neural network (CNN) system using CE images for disease surveillance of primary small-bowel FL. METHODS We enrolled 26 consecutive patients with primary small-bowel FL diagnosed between January 2011 and January 2021 who underwent CE before and after a watch-and-wait strategy or chemotherapy. Disease surveillance by the CNN system was evaluated by the percentage of FL-detected images among all CE images of the small-bowel mucosa. RESULTS Eighteen cases (69%) were managed with a watch-and-wait approach, and 8 cases (31%) were treated with chemotherapy. Among the 18 cases managed with the watch-and-wait approach, the outcome of lesion evaluation by the CNN system was almost the same in 13 cases (72%), aggravation in 4 (22%), and improvement in 1 (6%). Among the 8 cases treated with chemotherapy, the outcome of lesion evaluation by the CNN system was improvement in 5 cases (63%), almost the same in 2 (25%), and aggravation in 1 (12%). The physician and CNN system reported similar results regarding disease surveillance evaluation in 23 of 26 cases (88%), whereas a discrepancy between the 2 was found in the remaining 3 cases (12%), attributed to poor small-bowel cleansing level. CONCLUSIONS Disease surveillance evaluation of primary small-bowel FL using CE images by the developed CNN system was useful under the condition of excellent small-bowel cleansing level.
Collapse
Affiliation(s)
- Akihiko Sumioka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiyoshi Tsuboi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yuka Matsubara
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Issei Hirata
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ryo Yuge
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumio Shimamoto
- Faculty of Health Sciences, Hiroshima Shudo University, Hiroshima, Japan
| | - Tomohiro Tada
- AI Medical Service Inc, Tokyo, Japan; Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
6
|
Garcia A, Qureshi M, Dhawan I, Allen A, Budak-Alpdogan T, Giordano S. Multifocal Follicular Lymphoma Isolated to the Gastrointestinal Tract: A Rare Finding. ACG Case Rep J 2023; 10:e01215. [PMID: 38107609 PMCID: PMC10723842 DOI: 10.14309/crj.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 12/19/2023] Open
Abstract
Follicular lymphoma (FL) is a common form of non-Hodgkin lymphoma. Although extranodal involvement of the gastrointestinal (GI) tract is common in lymphomas, primary GI-FL confined to the GI tract is relatively rare. The disease process is typically indolent in nature and usually incidentally found. Among this subset of patients, the duodenum and terminal ileum tend to be the most common site of origin. Here, we present a rare case of primary multifocal GI-FL that found incidentally during routine colonoscopy with subsequent esophagogastroduodenoscopy and video capsule endoscopy revealing duodenal, jejunal, and sigmoid colon involvement.
Collapse
Affiliation(s)
| | - Mahir Qureshi
- Department of Medicine, Cooper University Hospital, Camden, NJ
| | - Ishita Dhawan
- Department of Gastroenterology, Cooper University Hospital, Camden, NJ
| | | | | | - Samuel Giordano
- Department of Gastroenterology, Cooper University Hospital, Camden, NJ
| |
Collapse
|
7
|
Tran QT, Nguyen Duy T, Nguyen-Tran BS, Nguyen-Thanh T, Ngo QT, Tran Thi NP, Le V, Dang-Cong T. Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study. Diagnostics (Basel) 2023; 13:2767. [PMID: 37685305 PMCID: PMC10486743 DOI: 10.3390/diagnostics13172767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Extranodal non-Hodgkin lymphoma (NHL) is more prevalent in the gastrointestinal (GI) tract than in other sites. This study aimed to determine the endoscopic characteristics of primary gastrointestinal non-Hodgkin lymphomas. Methods: We investigated 140 patients from three tertiary referral hospitals with primary malignant lymphoma of the gastrointestinal tract. Characteristics of the lesions were evaluated and analyzed using image-enhanced endoscopy, endoscopic ultrasound, and histopathology. Results: The median age was 60.5 (range: 11-99), and 59 (42.1%) were female. The most frequent complaint was abdominal pain (74.3%), followed by bloody feces (10%) and diarrhea (2.9%). B symptoms were observed in 15 (10.7%) patients. GI obstruction was the most common complication (10.0%), followed by hemorrhage (7.9%) and perforation (1.5%). Regarding endoscopic findings, the identified sites were the following: the stomach (61.4%), colon (10%), small intestine (10%), ileocecum (8.6%), rectum (6.4%), and duodenum (3.6%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are most prevalent in the stomach. Helicobacter pylori was identified in 46 cases (39.0%), with MALT lymphoma being the most infected subtype. Nearly all gastrointestinal non-Hodgkin lymphomas manifested as superficial type (25-59.6%) and ulcer type (15.6-50%) under endoscopy. We found that fungating type and protruding with ulcer type were more frequent types of aggressive lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) compared to the indolent types (MALT lymphoma, follicular lymphoma, duodenal-type follicular lymphoma, and small lymphocytic lymphoma) (p < 0.05). Conclusions: This study showed that most subtypes of gastrointestinal non-Hodgkin lymphomas exhibited same endoscopic features (superficial type and ulcer type). Aggressive gastrointestinal non-Hodgkin lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) were highly suspected when fungating lesions and protruding with ulcer lesions were encountered under endoscopy. Endoscopists should be aware of the connection between enhanced endoscopic characteristics and histological varieties of gastrointestinal lymphoma to improve diagnosis.
Collapse
Affiliation(s)
- Quang Trung Tran
- Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany;
- Gastroenterology-Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue 49000, Vietnam
| | - Thinh Nguyen Duy
- Faculty of Medicine and Pharmacy, Tay Nguyen University, 567 Le Duan Street, Buon Ma Thuot 63000, Vietnam;
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Bao Song Nguyen-Tran
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Tung Nguyen-Thanh
- Faculty of Basic Science, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam;
| | - Quy Tran Ngo
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Nam Phuong Tran Thi
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Vi Le
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
- Department of Pathology, Khanh Hoa Oncology Hospital, 229 Nguyen Khuyen Street, Nha Trang 57000, Vietnam
| | - Thuan Dang-Cong
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| |
Collapse
|
8
|
Watanabe T. Recent advances in treatment of nodal and gastrointestinal follicular lymphoma. World J Gastroenterol 2023; 29:3574-3594. [PMID: 37398889 PMCID: PMC10311612 DOI: 10.3748/wjg.v29.i23.3574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
Follicular lymphoma (FL) is the most common low-grade lymphoma, and although nodal FL is highly responsive to treatment, the majority of patients relapse repeatedly, and the disease has been incurable with a poor prognosis. However, primary FL of the gastrointestinal tract has been increasingly detected in Japan, especially due to recent advances in small bowel endoscopy and increased opportunities for endoscopic examinations and endoscopic diagnosis. However, many cases are detected at an early stage, and the prognosis is good in many cases. In contrast, in Europe and the United States, gastrointestinal FL has long been considered to be present in 12%-24% of Stage-IV patients, and the number of advanced gastrointestinal cases is expected to increase. This editorial provides an overview of the recent therapeutic advances in nodal FL, including antibody-targeted therapy, bispecific antibody therapy, epigenetic modulation, and chimeric antigen receptor T-cell therapy, and reviews the latest therapeutic manuscripts published in the past year. Based on an understanding of the therapeutic advances in nodal FL, we also discuss future possibilities for gastroenterologists to treat gastrointestinal FL, especially in advanced cases.
Collapse
Affiliation(s)
- Takuya Watanabe
- Department of Internal Medicine and Gastroenterology, Watanabe Internal Medicine Aoyama Clinic, Niigata-city 9502002, Japan
| |
Collapse
|
9
|
Kim H, Shin D, Son SM, Cho J, Kim JE, Kim Y, Jeon TS, Ko YH. Clinicopathological and molecular genetic characteristics of primary gastric follicular lymphoma ☆,☆☆,☆☆☆. Hum Pathol 2023; 136:114-122. [PMID: 37054783 DOI: 10.1016/j.humpath.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Primary gastric follicular lymphomas (FLs) have been rarely reported and little is known about their characteristics. In the present study, we report five cases of primary gastric FL and describe their clinicopathological and molecular genetic features. A total of seven samples from five patients were investigated for clinicopathological characteristics and somatic mutations by the targeted sequencing of 50 lymphoma-related genes. Two cases were identified as slightly elevated submucosal tumors and three cases as polypoid tumors. Histologically, all cases were low-grade FLs. The immuno-profile was CD20+/CD10+/BCL2+ in four cases and CD20+/CD10+/BCL2- in one case. Immunostaining pattern for CD21 was similar to that of classic FL. BCL2 rearrangement was not identified in fluorescence in situ hybridization studies in any of the five cases. NGS analysis showed mutations in genes involved in epigenetic modifications (KMT2D, ARID1A, EP300, CREBBP), NK-kB pathway (CARD11), and JAK-STAT pathway as found in classic follicular lymphoma. All cases presented with clinical I without the involvement of regional or systemic lymph nodes. Four patients were well, whereas one patient who received endoscopic mucosal resection of tumor without additional chemotherapy or radiotherapy experienced three relapses. In conclusion, primary gastric FL is characterized by a low-grade neoplasm with infrequent BCL2 rearrangement. After resection of the lesion, additional treatment such as radiation therapy or chemotherapy is required as there is a possibility of recurrence.
Collapse
Affiliation(s)
- Hyunsung Kim
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, South Korea
| | - Donghoon Shin
- Department of Pathology, Yangsan Hospital, Pusan National University College of Medicine, Yangsan 50612, South Korea
| | - Seng-Myoung Son
- Department of Pathology, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul 06351, South Korea
| | - Ji Eun Kim
- Department of Pathology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, South Korea
| | - Yeseul Kim
- Department of Pathology, Anam Hospital, Korea University College of Medicine, Seoul 02841, South Korea
| | - Tae-Sung Jeon
- Department of Pathology, Guro Hospital, Korea University College of Medicine, Seoul 08308, South Korea
| | - Young Hyeh Ko
- Department of Pathology, Guro Hospital, Korea University College of Medicine, Seoul 08308, South Korea; Department of Pathology, Cheju Halla General Hospital, Jeju 63127, South Korea.
| |
Collapse
|
10
|
Dias E, Andrade P, Cardoso H, Gullo I, Fonseca E, Macedo G. Primary small bowel follicular lymphoma: the role of balloon-assisted enteroscopy in diagnosis and follow-up. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:43-44. [PMID: 35656922 DOI: 10.17235/reed.2022.8943/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An asymptomatic 38-year-old male with no significant previous medical history performed routine laboratory studies that revealed iron-deficiency anemia. Esophagogastroduodenoscopy and colonoscopy were unremarkable and he undergone videocapsule endoscopy that revealed multiple small polyps along jejunum and ileum. Double-balloon enteroscopy confirmed the presence of scattered small whitish nodules and small polyps carpeting segments of jejunal mucosal and sometimes forming conglomerates with a nodular appearance. Histopathological examination showed lamina propria expansion by neoplastic follicles, predominantly composed by small lymphoid cells that, by immunohistochemistry, showed expression of CD20, CD10 and bcl-2. Computed tomography scan of abdomen and pelvis did not reveal systemic involvement, consistent with primary small bowel follicular lymphoma. Chemotherapy was started and, at reevaluation enteroscopy, although nodular jejunal segments persisted, biopsies did not show involvement by lymphoproliferative disease, which was interpreted as complete remission. Periodic clinical and biochemical evaluation and annual enteroscopic surveillance was maintained and, after three years, local recurrence of low-grade follicular lymphoma was detected. As previously, there was no evidence of systemic involvement and the decision was to maintain close surveillance. After one year, the patient remains asymptomatic and without evidence of disease progression. This case illustrates the essential role of balloon-assisted enteroscopy for diagnosis and surveillance of primary small bowel follicular lymphoma.
Collapse
Affiliation(s)
- Emanuel Dias
- Gastrenterology , Centro Hospitalar Universitário de São João, Portugal
| | | | - Hélder Cardoso
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Irene Gullo
- Pathology, Centro Hospitalar Universitário de São João
| | - Elsa Fonseca
- Pathology , Centro Hospitalar Universitário de São João, Portugal
| | - Guilherme Macedo
- Gastroenterology , Centro Hospitalar Universitário de São João, Portugal
| |
Collapse
|
11
|
Zhu KL, Lin MJ, Xu HZ, Lu YP, Yang XN. A case report of giant primary esophageal follicular lymphoma. J Dig Dis 2022; 23:660-663. [PMID: 36428103 DOI: 10.1111/1751-2980.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/24/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Kai Lun Zhu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China.,Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Meng Jie Lin
- Department of Pathology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Hong Zhi Xu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Ya Pi Lu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Xiao Ning Yang
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| |
Collapse
|
12
|
Ascites as First Atypical and Only Clinical Manifestation of De Novo Follicular Lymphoma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101381. [PMID: 36295542 PMCID: PMC9610819 DOI: 10.3390/medicina58101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
Follicular lymphoma is the most common indolent non-Hodgkin’s lymphoma and is usually initially detected in lymph nodes. Primary extranodal NHL is most commonly primarily localized in the gastrointestinal tract. We present one unusual case of ileum FL with ascites as the first clinical sign. The 73-year-old female patient was presented to the emergency department for evaluation of mild abdominal pain and abdominal swelling that had been going on for three days followed by bloating and occasional pain in the spine. The abdominal contrast-enhanced CT revealed the contrast stagnation in the distal part of the ileum. The ileum wall about 11 cm in length was thickened up to 2.9 cm and the tumor mass infiltrated all layers of ileum mesenteric lymphadenopathy up to 2 cm in diameter and significant ascites. On the upper ileum wall, the vegetative mass was described 3 cm in diameter. The patient had an emergent laparotomy with the ileocolic resection and latero-lateral ileocolic anastomosis. The microscopy finding of terminal ileum and the regional lymph nodes showed domination of cleaved cells with irregular nuclei which correspond to centrocytes. There were 0–15 large non-cleaved cells corresponding to centroblast in the microscopy high-power field. The final diagnosis was follicular lymphoma, the clinical stage 2E and histological grade by Berard and Mann criteria 1–2.
Collapse
|
13
|
Minemura T, Kikuchi S, Mihara H, Kamihara Y, Wada A, Fuchino M, Nanjo S, Noguchi A, Minamisaka T, Murakami J, Yasuda I, Sato T. Protein-losing Enteropathy Complicated with Primary Intestinal Follicular Lymphoma. Intern Med 2022; 61:2051-2055. [PMID: 34840227 PMCID: PMC9334233 DOI: 10.2169/internalmedicine.8261-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Protein-losing enteropathy (PLE) is a rare syndrome characterized by hypoproteinemia due to gastrointestinal (GI) protein loss. Primary intestinal follicular lymphoma (PIFL), a specific variant of follicular lymphoma with essential only GI involvement, has not been reported as an etiology of PLE. We herein report a case of PLE complicated with PIFL that was successfully treated with rituximab, resulting in rapid improvement of PLE and a complete response of PIFL. Macroscopic findings of ulcerative lesions with diffuse involvement, which were precisely described by capsule and double-balloon enteroscopy at the diagnosis, also improved following the treatment. This case provides a clue suggesting factors that promote PLE in PIFL.
Collapse
Affiliation(s)
- Tomoki Minemura
- Department of Hematology, Toyama University Hospital, Japan
- Center for Medical Residency Training, Toyama University Hospital, Japan
| | - Shohei Kikuchi
- Department of Hematology, Toyama University Hospital, Japan
| | - Hiroshi Mihara
- Third Department of Internal Medicine, Toyama University Hospital, Japan
| | | | - Akinori Wada
- Department of Hematology, Toyama University Hospital, Japan
| | - Mayo Fuchino
- Third Department of Internal Medicine, Toyama University Hospital, Japan
| | - Sohachi Nanjo
- Third Department of Internal Medicine, Toyama University Hospital, Japan
| | - Akira Noguchi
- Department of Diagnostic Pathology, Toyama University Hospital, Japan
| | | | - Jun Murakami
- Division of Transfusion Medicine and Cell Therapy, Toyama University Hospital, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Toyama University Hospital, Japan
| | - Tsutomu Sato
- Department of Hematology, Toyama University Hospital, Japan
| |
Collapse
|
14
|
Ahn JY. Gastrointestinal Tract Lymphoma. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2022. [DOI: 10.7704/kjhugr.2021.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
15
|
Matysiak-Budnik T, Jamet P, Chapelle N, Fabiani B, Coppo P, Ruskoné-Fourmestraux A. 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). Gut Liver 2022; 16:207-215. [PMID: 35249892 PMCID: PMC8924797 DOI: 10.5009/gnl210300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background/Aims Methods Results Conclusions
Collapse
Affiliation(s)
- Tamara Matysiak-Budnik
- IMAD, Department of Gastroenterology and Digestive Oncology, Hotel Dieu Hospital, Nantes, France
- UMR Inserm 1235, Nantes, France
| | - Philippe Jamet
- IMAD, Department of Gastroenterology and Digestive Oncology, Hotel Dieu Hospital, Nantes, France
| | - Nicolas Chapelle
- IMAD, Department of Gastroenterology and Digestive Oncology, Hotel Dieu Hospital, Nantes, France
- INSERM UMR 1064, University of Nantes, Nantes, France
| | - Bettina Fabiani
- Department of Pathology, Saint Antoine Hospital AP-HP, Paris, France
| | - Paul Coppo
- Department of Hematology, Saint Antoine Hospital AP-HP, Paris, France
| | - Agnès Ruskoné-Fourmestraux
- Gastroenterology, Saint Antoine Hospital AP-HP, Paris, France
- French Federation of Digestive Oncology, Dijon, France
| |
Collapse
|
16
|
Colo-enteric fistula associated with diffuse large B cell lymphoma that resulted in gastrointestinal bleeding: A case report and literature review. Int J Surg Case Rep 2022; 91:106798. [PMID: 35131626 PMCID: PMC8829056 DOI: 10.1016/j.ijscr.2022.106798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
|
17
|
Kuroda K, Lucia A. Small Bowel Obstruction as an Initial Presentation of Mesenteric Follicular Lymphoma: Case Report and Literature Review. Cureus 2022; 14:e21566. [PMID: 35228925 PMCID: PMC8865912 DOI: 10.7759/cureus.21566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/12/2022] Open
Abstract
Follicular lymphoma is the second most common type of B-cell non-Hodgkin lymphoma. It is known as one of the indolent lymphomas. Although some cases presenting with abdominal masses with or without symptoms have been reported, generally, primary extranodal follicular lymphoma is uncommon. Moreover, small bowel obstruction (SBO) as an initial presentation is extremely uncommon. We encountered a unique case of mesenteric follicular lymphoma that presented with SBO as the initial clinical presentation. A 61-year-old male presented with a three-day history of abdominal pain and recurrent vomiting. Abdominopelvic computed tomography revealed air-fluid levels in multiple small bowel loops, with a transition point associated with a mass-like mesenteric abnormality. The small bowel was resected, and a wedge resection was performed to relieve the obstruction and make a diagnosis. Histopathology and immunohistochemical staining confirmed the diagnosis of follicular B-cell lymphoma. Mesenteric lymphomas are less likely to present with SBO as the initial clinical presentation due to their extraluminal location. According to the literature review on the types of lymphomas that cause SBO, follicular lymphoma accounted for only 4.9% of lymphoma cases with SBO due to its indolent course.
Collapse
|
18
|
Suzuki H, Hamada Y, Tanaka K, Horiki N, Nakagawa H. Primary Gastrointestinal Follicular Lymphoma Presenting With Bowel Stenosis. Cureus 2022; 14:e21278. [PMID: 35178328 PMCID: PMC8843071 DOI: 10.7759/cureus.21278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/27/2022] Open
Abstract
Primary follicular lymphomas of the small bowel generally present with small whitish nodules and masses or polyp-like lesions; cases with other morphologies are extremely rare. We experienced a case of primary follicular lymphoma that presented with small bowel stenosis. The lesion needed to be differentiated from other causes, such as bowel tuberculosis, non-steroidal anti-inflammatory drug-related ulcers, Crohn’s disease, small bowel ischemia, trauma, and idiopathic bowel stenosis, but endoscopic biopsies did not result in a definite diagnosis. Therefore, the lesion was surgically resected and, consequently, a diagnosis of follicular lymphoma of the small bowel was finally made. We report the characteristics and macroscopic findings of follicular lymphoma of the small bowel along with a review of relevant literature.
Collapse
|
19
|
Atypical jejunal follicular lymphoma with severe stricture. Clin J Gastroenterol 2021; 15:101-106. [PMID: 34617259 DOI: 10.1007/s12328-021-01530-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
The typical macroscopic appearance of gastrointestinal follicular lymphoma (FL) are multiple white granules or small white polyps, called multiple lymphomatous polyposis type, and subsequent mass lesions with or without ulceration; however, an ulcer type with a stricture is extremely rare. We report a case of a 79-year-old male with severe jejunal stricture due to FL with an uncommon chromosomal translocation t(2;18)(p12;q21). The patient was treated with jejunectomy subsequent rituximab monotherapy with a favorable response. The presence of the stricture made its endoscopic diagnosis confusing; however, it was certainly accompanied by the distinctive white granules on the surface of the tumor as seen in typical FL. With the possibility of an FL with stricture in mind, it is important to collect subtle endoscopic findings of the surrounding mucosa carefully, in order to arrive at an accurate endoscopic diagnosis and eventually to the proper therapeutic option.
Collapse
|
20
|
Iwamuro M, Fujii N, Tanaka T, Kanzaki H, Kawano S, Kawahara Y, Okada H. Squamous Metaplasia of the Stomach Associated with Lymphoma Infiltration. Intern Med 2021; 60:2229-2234. [PMID: 33612676 PMCID: PMC8355407 DOI: 10.2169/internalmedicine.6271-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We herein report a patient who presented with follicular lymphoma. Although the stomach was initially intact, mucosal redness and multiple erosions appeared in the gastric body owing to infiltration of the follicular lymphoma cells. Subsequently, a slightly depressed, white area lacking gastric mucosal structure was detected in the lesser curvature of the gastric cardia and body, where lymphoma cell infiltration was also pathologically observed beneath the stratified squamous epithelium. This case indicated that, although infrequent, prolonged mucosal injury owing to lymphoma infiltration can cause squamous metaplasia in the stomach.
Collapse
Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | | | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| |
Collapse
|
21
|
Small S, Barnea Slonim L, Williams C, Karmali R. B Cell Lymphomas of the GI Tract. Curr Gastroenterol Rep 2021; 23:9. [PMID: 33963950 DOI: 10.1007/s11894-021-00811-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE OF THE REVIEW Primary GI lymphomas of B cell origin are a diverse group of lymphomas. In this article, we provide an overview of the diagnosis, pathologic and molecular features, and management of these varied lymphomas. RECENT FINDINGS The most common primary GI lymphomas are diffuse large B cell lymphoma (DLBCL) and marginal zone lymphomas (MZL), but follicular lymphomas (FL), mantle cell lymphomas (MCL), post-transplant lymphoproliferative disorders (PTLD), and Burkitt lymphoma of the GI tract also occur. Many features of these lymphomas are similar to their nodal counterparts, but certain clinical and biological aspects are unique. Diagnostic and treatment strategies for these lymphomas continue to evolve over time. There are ongoing discoveries about the unique pathophysiology, molecular characteristics, and complications of primary B cell GI lymphomas that are already leading to improvements in management of this histologically diverse set of lymphomas.
Collapse
Affiliation(s)
- Sara Small
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA
| | | | - Corinne Williams
- Robert H. Lurie Comprehensive Cancer Center, 675 N. St. Clair St.Fl 21 Ste. 100, Chicago, IL, 60611, USA
| | - Reem Karmali
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA.
- Robert H. Lurie Comprehensive Cancer Center, 675 N. St. Clair St.Fl 21 Ste. 100, Chicago, IL, 60611, USA.
| |
Collapse
|
22
|
Alvarez-Lesmes J, Chapman JR, Cassidy D, Zhou Y, Garcia-Buitrago M, Montgomery EA, Lossos IS, Sussman D, Poveda J. Gastrointestinal Tract Lymphomas: A Review of the Most Commonly Encountered Lymphomas. Arch Pathol Lab Med 2021; 145:1585-1596. [PMID: 33836528 DOI: 10.5858/arpa.2020-0661-ra] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The gastrointestinal (GI) tract is the most common site of extranodal non-Hodgkin lymphoma, accounting for 20% to 40% of all extranodal lymphomas. The majority of these are systemic processes secondarily involving the GI tract. Primary GI lymphomas are less common, accounting for approximately 10% to 15% of all non-Hodgkin lymphoma. Most non-Hodgkin lymphoma involving the GI tract are of B-cell lineage, of which diffuse large B-cell lymphoma is the most common subtype, irrespective of location. OBJECTIVE.— To review the lymphoproliferative neoplasms of B-cell and T-cell lineage involving the luminal GI tract according to the most prevalent subtypes at each anatomic site. DATA SOURCE.— Systematic search of the PubMed database for updated literature on GI lymphomas epidemiology, subtypes, clinical, endoscopic, and genetic findings. Histologic images are derived from our collection of clinical cases. CONCLUSIONS.— The GI tract is the most common site of extranodal lymphoproliferative neoplasms. Recognition of the most frequently encountered GI lymphomas is imperative for patient management and treatment.
Collapse
Affiliation(s)
- Jessica Alvarez-Lesmes
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Jennifer R Chapman
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Daniel Cassidy
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Yi Zhou
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Monica Garcia-Buitrago
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Elizabeth A Montgomery
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Izidore S Lossos
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida (Lossos).,Department of Molecular and Cellular Pharmacology (Lossos), University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Sussman
- Division of Digestive Health and Liver Diseases (Sussman), University of Miami Miller School of Medicine, Miami, Florida
| | - Julio Poveda
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| |
Collapse
|
23
|
Abstract
Hematologic malignancies include several lymphoproliferative and myeloproliferative disorders, many of which are frequently encountered in current health care settings. These malignancies frequently affect the gastrointestinal (GI) tract, either by secondary extranodal or extramedullary extension to the GI tract, or as a primary process arising in the GI tract. In fact, the GI tract may represent the most common extranodal site of involvement in many of them, such as lymphoma. Furthermore, in the current era of improved cancer treatment and advanced transplant procedures with increased survival, it has been quite common to encounter GI involvement by these malignancies through the disease course. Post-transplant lymphoproliferative disorder following kidney transplantation, for example, very commonly involves the GI tract. Other conditions that can involve the GI tract include multiple myeloma, plasmacytoma, myeloid sarcoma, mastocytosis, and Castleman disease. Imaging diagnosis of these malignancies can be challenging, since they are much less common than primary GI cancers and both share many common imaging features as well. However, certain imaging features, particularly in combination with a matching clinical scenario, play a pivotal role in diagnosing these conditions and directing further evaluation. In this article, we review common and rare hematologic malignancies of the GI tract and discuss their pathophysiologic, clinical, and imaging features.
Collapse
|
24
|
Zeze K, Hirano A, Torisu T, Esaki M, Shibata H, Moriyama T, Umeno J, Fujioka S, Okamoto Y, Fuyuno Y, Matsuno Y, Kitazono T. Mucosal dysbiosis in patients with gastrointestinal follicular lymphoma. Hematol Oncol 2020; 38:181-188. [PMID: 31990065 DOI: 10.1002/hon.2717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/22/2022]
Abstract
Because the pathogenesis of gastrointestinal follicular lymphoma (GI-FL) remains unclear, no standardized treatment strategy has been established. Of the gastrointestinal lymphomas, gastric mucosa-associated lymphoid tissue lymphomas are strongly associated with Helicobacter pylori; hence, the microbiota may be involved in GI-FL pathogenesis. However, the association between GI-FL and the microbiota remains uninvestigated. Therefore, we compared the mucosal microbiotas of GI-FL patients with those of controls to identify microbiota changes in GI-FL patients. Mucosal biopsy samples were obtained from the second portion of the duodenum from 20 GI-FL patients with duodenal lesions and 20 controls. Subsequent 16S rRNA gene sequencing was performed on these samples. QIIME pipeline and LEfSe software were used to analyze the microbiota. The GI-FL patients had significantly lower alpha diversity (P = .049) than did the controls, with significant differences in the microbial composition (P = .023) evaluated by the beta diversity metrics between the two groups. Comparing the taxonomic compositions indicated that the genera Sporomusa, Rothia, and Prevotella and the family Gemellaceae were significantly less abundant in the GI-FL patients than in the controls. GI-FL patients presented altered duodenal mucosal microbial compositions, suggesting that the microbiota might be involved in the GI-FL pathogenesis.
Collapse
Affiliation(s)
- Keizo Zeze
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Hirano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Esaki
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | - Hiroki Shibata
- Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shin Fujioka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Okamoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Matsuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
25
|
Plummer RM, Beckman AK, Hupp MM, Courville EL, Williams SA, Linden MA. Diagnostic Utility of Performing Flow Cytometry on Provider-Submitted Endoscopically Collected Gastrointestinal Samples. ACTA ACUST UNITED AC 2020. [DOI: 10.4236/ojbd.2020.101001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
26
|
Sato J, Ishiwatari H, Ashida R, Sasaki K, Fujie S, Kaneko J, Satoh T, Matsubayashi H, Kishida Y, Yoshida M, Ito S, Kawata N, Imai K, Kakushima N, Takizawa K, Hotta K, Uesaka K, Ono H. Primary non-ampullary duodenal follicular lymphoma presenting with obstructive jaundice. Clin J Gastroenterol 2019; 13:214-218. [PMID: 31401784 DOI: 10.1007/s12328-019-01033-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/05/2019] [Indexed: 12/29/2022]
Abstract
Primary gastrointestinal follicular lymphoma is a rare disease. Follicular lymphoma does not cause any typical symptoms, although it usually shows the presence of multiple white granules on endoscopy. Few patients with follicular lymphoma present with the initial symptom of jaundice, which is usually associated with follicular lymphomas located in the papilla of Vater. Herein, we present the first case of a duodenal follicular lymphoma that presented with obstructive jaundice despite not being located in the ampulla, and it did not demonstrate the typical endoscopic findings of multiple white granules. A 72-year-old Japanese man with jaundice was referred to our hospital. Imaging revealed a hypovascular lesion extending into the second part of the duodenum and the pancreatic head, and the common bile duct was dilated upstream of the lesion. Biopsy of the lesion was negative for malignancy. Finally, we suspected the lesion as a pancreatic adenosquamous carcinoma, and not a typical pancreatic ductal carcinoma, because the lesion showed no pancreatic duct dilation and had a partially hyperechoic part within. Therefore, we performed pancreaticoduodenectomy. The final diagnosis was a duodenal follicular lymphoma. The findings of this case may assist in distinguishing between atypical follicular lymphoma and jaundice from pancreatic cancer.
Collapse
Affiliation(s)
- Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Hirotoshi Ishiwatari
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shinya Fujie
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Junichi Kaneko
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Tatsunori Satoh
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Yoshihiro Kishida
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| |
Collapse
|
27
|
Horie T, Hosoe N, Takabayashi K, Hayashi Y, Kamiya KJLL, Miyanaga R, Mizuno S, Fukuhara K, Fukuhara S, Naganuma M, Shimoda M, Ogata H, Kanai T. Endoscopic characteristics of small intestinal malignant tumors observed by balloon-assisted enteroscopy. World J Gastrointest Endosc 2019; 11:373-382. [PMID: 31205598 PMCID: PMC6556486 DOI: 10.4253/wjge.v11.i5.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Capsule endoscopy and balloon-assisted enteroscopy (BAE) enable visualization of rare small bowel conditions such as small intestinal malignant tumors. However, details of the endoscopic characteristics of small intestinal malignant tumors are still unknown.
AIM To elucidate the endoscopic characteristics of small intestinal malignant tumors.
METHODS From March 2005 to February 2017, 1328 BAE procedures were performed at Keio University Hospital. Of these procedures, malignant tumors were classified into three groups, Group 1: epithelial tumors including primary small intestinal cancer, metastatic small intestinal cancer, and direct small intestinal invasion by an adjacent organ cancer; Group 2: small intestinal malignant lymphoma; and Group 3, small intestinal gastrointestinal stromal tumors. We systematically collected clinical and endoscopic data from patients’ medical records to determine the endoscopic characteristics for each group.
RESULTS The number of patients in each group was 16 (Group 1), 22 (Group 2), and 6 (Group 3), and the percentage of solitary tumors was 100%, 45.5%, and 100%, respectively (P < 0.001). Patients’ clinical background parameters including age, symptoms, and laboratory data were not significantly different between the groups. Seventy-five percent of epithelial tumors (Group 1) were located in the upper small intestine (duodenum and ileum), and approximately 70% of gastrointestinal stromal tumors (Group 3) were located in the jejunum. Solitary protruding or mass-type tumors were not seen in malignant lymphoma (Group 2) (P < 0.001). Stenosis was seen more often in Group 1, (68.8%, 27.3%, and 0%; Group 1, 2, and 3, respectively; P = 0.004). Enlarged white villi inside and/or surrounding the tumor were seen in 12.5%, 54.5%, and 0% in Group 1, 2, and 3, respectively (P = 0.001).
CONCLUSION The differential diagnosis of small intestinal malignant tumors could be tentatively made based on BAE findings.
Collapse
Affiliation(s)
- Tomofumi Horie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Kenji JL Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Shinta Mizuno
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Kayoko Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Masayuki Shimoda
- Department of Pathology, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| |
Collapse
|
28
|
Kitamoto H, Kataoka T, Yamamoto S. Multiple Polypoid Lesions in the Ileum After Treatment for Primary Ileal Follicular Lymphoma. Gastroenterology 2019; 156:552-553. [PMID: 30201345 DOI: 10.1053/j.gastro.2018.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Hiroki Kitamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Shuji Yamamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
29
|
Abstract
RATIONALE Considering the low incidence of colorectal follicular lymphoma (FL) and its clinical features in endoscopic views, only a few studies have described the pathological diagnosis and treatment of this disease. This study aimed to reveal the overall process of clinical diagnosis and treatment of colorectal FL by conducting a case review. PATIENT CONCERNS A 27-year-old female presented to our department because of "severe bloody stool" lasting for more than 1 month. Her primary symptom was melena. Colonoscopy revealed widespread flat polyps with various immunophenotypes (CD10+, BCL2+, BCL6+, cyclin D1-, CD5-) in the colorectal area. DIAGNOSIS In accordance with manifestations on positron emission tomography-computed tomography (PET/CT), the patient was diagnosed with stage IV colorectal FL. INTERVENTIONS PET/CT reexamination after 2 courses of rituximab, cyclophosphamide, liposomal doxorubicin, vincristine sulfate, and hydroprednisone (R-CHOP) regimen and 3 courses of R-CHOP plus etoposide regimen for chemotherapy indicated a significant reduction in tumor burden. Subsequently, rituximab was administered alone in 2 treatment courses. OUTCOMES Lesions on PET/CT disappeared after reexamination. No recurrence was observed within the 12-month follow-up period. LESSONS Colorectal FL is a rare disease with an inert clinical course and is common in the ileocecal area. Endoscopic views show multiple polyps. Interventional treatment is usually provided after observation of clinical symptoms or during disease progression. The disease has a relatively good prognosis.
Collapse
|
30
|
Takahashi K, Bamba S, Kawahara M, Nishida A, Inatomi O, Sasaki M, Tsujikawa T, Kushima R, Sugimoto M, Kitoh K, Andoh A. Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series. Intest Res 2018; 16:628-634. [PMID: 30301328 PMCID: PMC6223446 DOI: 10.5217/ir.2018.00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/30/2018] [Indexed: 12/19/2022] Open
Abstract
The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying singleballoon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma.
Collapse
Affiliation(s)
| | - Shigeki Bamba
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
| | - Masahiro Kawahara
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Atsushi Nishida
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
| | - Tomoyuki Tsujikawa
- Department of Comprehensive Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Ryoji Kushima
- Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Mitsushige Sugimoto
- Division of Digestive Endoscopy, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Kitoh
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| |
Collapse
|
31
|
Takata K, Miyata-Takata T, Sato Y, Iwamuro M, Okada H, Tari A, Yoshino T. Gastrointestinal follicular lymphoma: Current knowledge and future challenges. Pathol Int 2018; 68:1-6. [PMID: 29292593 DOI: 10.1111/pin.12621] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/21/2017] [Indexed: 12/14/2022]
Abstract
The gastrointestinal (GI) tract is the most commonly involved site of extranodal follicular lymphoma (FL). GI-FL shows very indolent clinical behavior and localized at GI tract without any progression or transformation compared to nodal FL. The most frequently involved site of the GI tract was the duodenum followed by the jejunum and ileum, and only 15% of FL arising in the second part of the duodenum were localized there without scattered very small daughter lesions in other GI tract examined by double-balloon endoscopy. The typical macroscopic appearance of GI-FL was multiple white nodules. Microscopically, neoplastic cells were small- to medium-sized lymphoid cells and formed neoplastic follicles. Most of the cases (>95%) were histologically Grade 1 to 2 (low grade). Several pathological and molecular characteristics were seen in GI-FL (especially duodenal FL) compared with nodal FL: immunoglobulin heavy chain deviation to VH4 and VH5; memory B-cell immunophenotype; and molecular features shared by mucosa-associated lymphoid tissue lymphoma. Considering the pathological and molecular uniqueness of this disease, GI-FL should be separately managed from nodal FL.
Collapse
Affiliation(s)
- Katsuyoshi Takata
- Department of Lymphoid Cancer Research, British Columbia Cancer Research Centre, Vancouver, Canada.,Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Miyata-Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akira Tari
- Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
32
|
Lee H, Oh D, Yang K, Ko YH, Ahn YC, Kim WS, Kim SJ. Radiation Therapy Outcome and Clinical Features of Duodenal-Type Follicular Lymphoma. Cancer Res Treat 2018; 51:547-555. [PMID: 29986575 PMCID: PMC6473297 DOI: 10.4143/crt.2018.190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Duodenal-type follicular lymphoma (FL) is a rare variant of FL. There is still no consensus on the initial treatment, and clinical features including endoscopic findings are not familiar to most physicians. The objective of this study was to evaluate the outcome of patients who were initially treated with radiation therapy for duodenal-type FL. Materials and Methods We retrospectively analyzed 20 patients who were consecutively diagnosed with duodenaltype FL between 2008 and 2017. All patients received radiation therapywith curative intent. RESULTS The median age of the patients was 52 years (range, 26 to 66 years), and females were predominant. Most patients (n=18, 90%) had stage I disease, and were diagnosed by a regular health examination in an asymptomatic state. The histological grade was one in 19 patients (95%), and the endoscopic findings were diffuse nodular (n=8), whitish granular (n=8), and mixed pattern (n=4). Radiation therapy was delivered to 17 patients with 24 Gy in 12 fractions, and to three patients with 30.6-36 Gy in 18 fractions. All patients were evaluated with endoscopy for response to radiation therapy, and complete response was achieved in 19 patients (95%). At the time of analysis, all patients survived without any evidence of late toxicities related with radiation therapy. CONCLUSION Taken together, radiation therapy alone could be effective in controlling duodenal lesion. A further study with longer follow-up duration is warranted to confirm our findings.
Collapse
Affiliation(s)
- Hansang Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungmi Yang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
33
|
Pezzella M, Brogna B, Romano A, Torelli F, Esposito G, Petrillo M, Romano FM, Di Martino N, Reginelli A, Grassi R. Detecting a rare composite small bowel lymphoma by Magnetic Resonance Imaging coincidentally: A case report with radiological, surgical and histopathological features. Int J Surg Case Rep 2018; 46:50-55. [PMID: 29684805 PMCID: PMC6000764 DOI: 10.1016/j.ijscr.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/03/2018] [Accepted: 04/08/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Diagnosing lymphoma continues to prove challenging in the clinical practice. Composite lymphoma (CL) is defined by the coexistence of different lymphoma subtypes in the same anatomical location. This condition has seldom been witnessed in the gastrointestinal (GI) tract. We weren't able to find previous cases in the literature about small bowel CL with follicular lymphoma (FL) and classical Hodgkin lymphoma (CHL). Surgery is the treatment of choice to obtain accurate histology, to manage and prevent acute complications. We state that this work has been reported in line with the SCARE criteria. CASE PRESENTATION We describe an extremely rare case of small bowel CL, presenting as an intestinal bulky mass with circumferential infiltration of bowel loops. The small bowel tumor was incidentally detected by abdominal Magnetic Resonance Imaging (MRI) in a 64-year-old man who suffered from rectal discomfort and non-specific clinical symptoms. After this radiological finding, the patient underwent multiphase contrast computed tomography (MDCT) for initial staging and to study vascular involvement. Surgery was recommended to obtain an accurate diagnosis both due to initial symptoms of the intestinal obstruction and to avoid small bowel complications. The histopathological examination revealed a small bowel CL composed mainly of B cells FL with also CHL components. CONCLUSION It is important to note that involvement of the proximal ileal loops is very rare in small bowel lymphoma. MRI represents a precious diagnostic tool to evaluate the intra and extramural extent of the tumor.
Collapse
Affiliation(s)
- M Pezzella
- Department of General Surgery, University of Study of Campania 'Luigi Vanvitelli', 80138, Naples, Italy.
| | - B Brogna
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - A Romano
- Department of General Surgery, University of Study of Campania 'Luigi Vanvitelli', 80138, Naples, Italy
| | - F Torelli
- Department of General Surgery, University of Study of Campania 'Luigi Vanvitelli', 80138, Naples, Italy
| | - G Esposito
- Department of General Surgery, University of Study of Campania 'Luigi Vanvitelli', 80138, Naples, Italy
| | - M Petrillo
- Department of General Surgery, University of Study of Campania 'Luigi Vanvitelli', 80138, Naples, Italy
| | - F M Romano
- Department of General Surgery, University of Study of Campania 'Luigi Vanvitelli', 80138, Naples, Italy
| | - N Di Martino
- Department of General Surgery, University of Study of Campania 'Luigi Vanvitelli', 80138, Naples, Italy
| | - A Reginelli
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - R Grassi
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| |
Collapse
|
34
|
Kiesewetter B, Dolak W, Mayerhoefer ME, Simonitsch-Klupp I, Raderer M. Successful Clarithromycin Monotherapy in a Patient with Primary Follicular Lymphoma of the Duodenum. Case Rep Oncol 2018; 11:239-245. [PMID: 29805375 PMCID: PMC5968239 DOI: 10.1159/000488388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 01/30/2023] Open
Abstract
Primary follicular lymphoma of the duodenum (FL-D) constitutes a rare subtype of extranodal follicular lymphoma with a usually indolent course. To date, no distinct treatment recommendations have been defined for those patients. We report the case of a 58-year-old male patient presenting with endoscopically assessed, symptomatic FL-D who was treated with clarithromycin monotherapy in analogy to recent data for mucosa-associated lymphoid tissue lymphoma. Each treatment cycle consisted of clarithromycin 500 mg twice daily for 3 weeks followed by a 2-week break. After four cycles of treatment, the patient showed a very good response with normal macroscopic findings confirmed by endosonographic examination and only focal minimal residual disease of lymphoma persisting in the histological assessment. The patient is currently asymptomatic and without treatment for 24+ months. As clarithromycin combines antimicrobial and direct antiproliferative effects mediated through a variety of pleiotropic mechanisms, this appears to be an interesting treatment approach for indolent lymphoma, particularly in those where a chronic infectious background cannot be completely ruled out, i.e., gastrointestinal manifestations. We suggest further investigation of this treatment approach.
Collapse
Affiliation(s)
- Barbara Kiesewetter
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Werner Dolak
- Clinical Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marius E Mayerhoefer
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Markus Raderer
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
35
|
Boussios S, Zerdes I, Vassou A, Bareta E, Seraj E, Papoudou-Bai A, Pavlidis N, Batistatou A, Pentheroudakis G. Extranodal diffuse large B-cell lymphomas: A retrospective case series and review of the literature. Hematol Rep 2018; 10:7070. [PMID: 29721249 PMCID: PMC5907641 DOI: 10.4081/hr.2018.7070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 12/18/2022] Open
Abstract
Non-Hodgkin lymphomas commonly show extranodal involvement (25-30%) but primary diffuse large B-cell lymphomas (DLBCL) with extranodal localization represent clinically and molecularly distinct entities. The present study involved retrospective analysis of case records of 4 patients who were diagnosed with extranodal DLBCL between 2010 and 2016 at the Medical Oncology and Hematology Departments of the Ioannina University Hospital, Greece. Median age of presentation was 69 years (range 60-77 years). There were 2 males and 2 females. The sites of DLBCL involvement included adrenal gland, mandible, cervix uteri, and ileum. Two patients had B symptoms while none had bone marrow involvement. After staging workup, all the patients fell into IE stage. The treatment approach included chemotherapy combined with rituximab (R), whereas one patient received additionally irradiation therapy. Post-treatment positron emission tomography-computed tomography scan was performed in 3 patients. In terms of the outcome, 3 patients are alive in complete response, whereas one was lost in follow-up. Further prospective data analyses are required so as to better elucidate the biology and course of extranodal DLBCL.
Collapse
Affiliation(s)
- Stergios Boussios
- Department of Medical Oncology
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN)
| | - Ioannis Zerdes
- Department of Medical Oncology
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN)
| | - Amalia Vassou
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN)
- Department of Hematology
| | - Eleni Bareta
- Department of Medical Oncology
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN)
| | - Esmeralda Seraj
- Department of Medical Oncology
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN)
| | | | - Nicholas Pavlidis
- Department of Medical Oncology
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN)
| | - Anna Batistatou
- Department of Pathology, Medical School, University of Ioannina, Greece
| | - George Pentheroudakis
- Department of Medical Oncology
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN)
| |
Collapse
|
36
|
Fujishima F, Katsushima H, Fukuhara N, Konosu-Fukaya S, Nakamura Y, Sasano H, Ichinohasama R. Incidence Rate, Subtype Frequency, and Occurrence Site of Malignant Lymphoma in the Gastrointestinal Tract: Population-Based Analysis in Miyagi, Japan. TOHOKU J EXP MED 2018; 245:159-165. [DOI: 10.1620/tjem.245.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Fumiyoshi Fujishima
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine
| | | | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
| | - Sachiko Konosu-Fukaya
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hironobu Sasano
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine
| | | |
Collapse
|
37
|
Kim HJ, Choi CW, Park SB, Kim SJ. Gastric Follicular Lymphomas Presenting as Subepithelial Tumors: Two Cases. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.4.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hyeong Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
38
|
Nehme F, Rowe K, Palko W, Nassif I. Primary duodenal follicular lymphoma with late disseminated nodal relapse responsive to rituximab monotherapy: A case report. Mol Clin Oncol 2017; 7:911-914. [PMID: 29181187 DOI: 10.3892/mco.2017.1388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/17/2017] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal follicular lymphoma is a rare malignancy accounting for only 1-3.6% of primary non-Hodgkin lymphomas of the gastrointestinal tract and it is a relatively new clinical entity that was recently classified as a distinct variant of systemic follicular lymphoma. Therefore, data regarding long-term outcome are currently lacking. In addition, a consensus on the management of this disease has not been established and treatment strategies are derived from systemic follicular lymphoma. We herein report the case of a 51-year-old female patient diagnosed with duodenal follicular lymphoma who had nodal relapse nearly 5 years after complete remission. The patient was successfully treated with a 4-week course of rituximab during the initial diagnosis and relapse. To the best of our knowledge, this is the first case report to demonstrate the efficacy of a 4-week course of rituximab during both the initial diagnosis and nodal relapse. The aim of this report was to add to the limited available data on the treatment of gastrointestinal follicular lymphoma.
Collapse
Affiliation(s)
- Fredy Nehme
- Department of Internal Medicine, Kansas University School of Medicine, Wichita, KS 67214, USA
| | - Kyle Rowe
- Department of Internal Medicine, Kansas University School of Medicine, Wichita, KS 67214, USA
| | - William Palko
- Department of Pathology, Kansas University School of Medicine, Wichita, KS 67214, USA
| | - Imad Nassif
- Department of Internal Medicine, Kansas University School of Medicine, Wichita, KS 67214, USA
| |
Collapse
|
39
|
Juanmartiñena Fernández JF, Fernández-Urién I, Iglesias Picazo R, Aznárez Barrio MR, Montes Díaz M, Cebrian García A, Vila Costas JJ. Primary follicular lymphoma of the gastrointestinal tract: Endoscopic findings and role of capsule endoscopy. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:621-623. [PMID: 27743786 DOI: 10.1016/j.gastrohep.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/08/2016] [Accepted: 08/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Iñaki Fernández-Urién
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Rosa Iglesias Picazo
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - Marta Montes Díaz
- Servicio de Patología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Alba Cebrian García
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Juan José Vila Costas
- Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| |
Collapse
|
40
|
Chouhan J, Batra S, Gupta R, Guha S. Gastrointestinal follicular lymphoma: using primary site as a predictor of survival. Cancer Med 2016; 5:2669-2677. [PMID: 27696758 PMCID: PMC5083718 DOI: 10.1002/cam4.763] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 12/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jay Chouhan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sachin Batra
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Rohan Gupta
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sushovan Guha
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas. .,Department of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, Houston, Texas.
| |
Collapse
|
41
|
Magnifying Endoscopic Features of Follicular Lymphoma Involving the Stomach: A Report of Two Cases. Case Rep Gastrointest Med 2016; 2016:2082698. [PMID: 27747111 PMCID: PMC5055949 DOI: 10.1155/2016/2082698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/28/2016] [Indexed: 02/06/2023] Open
Abstract
A 70-year-old woman presented with follicular lymphoma involving the stomach, duodenum, jejunum, bone, and lymph nodes. Esophagogastroduodenoscopy revealed multiple depressed lesions in the stomach. Examination with magnifying endoscopy showed branched abnormal vessels along with gastric pits, which were irregularly shaped but were preserved. The second case was a 45-year-old man diagnosed with stage II1 follicular lymphoma with duodenal, ileal, and colorectal involvement, as well as lymphadenopathy of the mesenteric lymph nodes. Esophagogastroduodenoscopy performed six years after the diagnosis revealed multiple erosions in the gastric body and angle. Magnifying endoscopic observation with narrow-band imaging showed that the gastric pits were only partially preserved and were destroyed in most of the stomach. Branched abnormal vessels were also seen. Pathological features were consistent with follicular lymphoma in both cases. The structural differences reported between the two cases appear to reflect distinct pathologies. Disappearance of gastric pits in the latter case seems to result from loss of epithelial cells, probably due to chronic inflammation. In both cases, branched abnormal vasculature was observed. These two cases suggest that magnified observations of abnormal branched microvasculature may facilitate endoscopic detection and recognition of the extent of gastric involvement in patients with follicular lymphoma.
Collapse
|
42
|
WEO Newsletter. Dig Endosc 2016; 28:694-8. [PMID: 27587365 DOI: 10.1111/den.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
43
|
|
44
|
Harada A, Oguchi M, Terui Y, Takeuchi K, Igarashi M, Kozuka T, Harada K, Uno T, Hatake K. Radiation therapy for localized duodenal low-grade follicular lymphoma. JOURNAL OF RADIATION RESEARCH 2016; 57:412-417. [PMID: 27009323 PMCID: PMC4973641 DOI: 10.1093/jrr/rrw011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the initial treatment results and toxicities of radiation therapy for patients with early stage low-grade follicular lymphoma (FL) arising from the duodenum. We reviewed 21 consecutive patients with early stage duodenal FL treated with radiation therapy between January 2005 and December 2013 at the Cancer Institute Hospital, Tokyo. The characteristics of patients were: median age 62 years (range, 46-79 years), gender (male, 6; female, 15), clinical stage (I, 20; II1, 1), histological grade (I, 17; II, 4). All patients were treated with radiation therapy alone. The median radiation dose was 30.6 Gy (range, 30.6-39.6) in 17 fractions. The involved-site radiation therapy was delivered to the whole duodenum. The median follow-up time was 43.2 months (range 21.4-109.3). The 3-year overall survival (OS), relapse-free survival (RFS) and local control (LC) rates were 94.7%, 79.3% and 100%, respectively. There were four relapses documented outside the treated volumes: two in the gastrointestinal tract (jejunum, terminal ileum), one in an abdominal lymph node (mesenteric lymph node) and one in the bone marrow. None died of the disease; one death was due to acute myeloid leukemia. No toxicities greater than Grade 1 were observed during treatment and over the follow-up time. The 30.6 Gy of involved-site radiation therapy provided excellent local control with very low toxicities. Radiation therapy could be an effective and safe treatment option for patients with localized low grade FL arising from the duodenum.
Collapse
Affiliation(s)
- Arisa Harada
- Radiation Oncology Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kouto-ku, Tokyo 135-8550, Japan
| | - Masahiko Oguchi
- Radiation Oncology Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kouto-ku, Tokyo 135-8550, Japan
| | - Yasuhito Terui
- Hematology Oncology Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kouto-ku, Tokyo 135-8550, Japan
| | - Kengo Takeuchi
- Pathology Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kouto-ku, Tokyo 135-8550, Japan
| | - Masahiro Igarashi
- Endoscopy Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kouto-ku, Tokyo 135-8550, Japan
| | - Takuyo Kozuka
- Radiation Oncology Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kouto-ku, Tokyo 135-8550, Japan
| | - Ken Harada
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Uno
- Department of Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kiyohiko Hatake
- Hematology Oncology Department, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Kouto-ku, Tokyo 135-8550, Japan
| |
Collapse
|
45
|
Moy BT, Wilmot J, Ballesteros E, Forouhar F, Vaziri H. Primary Follicular Lymphoma of the Gastrointestinal Tract: Case Report and Review. J Gastrointest Cancer 2016; 47:255-63. [PMID: 27277664 DOI: 10.1007/s12029-016-9847-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary gastrointestinal follicular lymphoma (GI-FL) is considered a rare disease with fewer than 400 cases reported in the literature. It accounts for roughly 1-3 % of GI non-Hodgkins lymphomas (NHL). It originates in the GI tract and typically affects small bowel. The disease has an indolent course, and a prolonged survival can be expected in most cases. Due to its rarity, an optimal diagnostic work up and treatment plan has not been well established. METHODS Endoscopic evaluation of the entire gastrointestinal (GI) tract using esophagogastroduodenoscopy (EGD), wireless capsule endoscopy, double-balloon enteroscopy, colonoscopy, and whole body examination with fluorodeoxyglucose-positron emission tomography (FDG-PET) has been suggested to more accurately stage the disease and guide the treatment plan. RESULTS Treatment options for GI follicular lymphoma include watch and wait strategy, surgery, chemotherapy, radiation, immuno-radiotherapy, or a combination of these modalities. CONCLUSION In this article, we have summarized the existing information regarding clinical presentation, diagnostic evaluation, and treatment options for this rare entity after presenting a case of GI-FL who was diagnosed during an EGD for evaluation of belching, heartburn, and weight loss.
Collapse
Affiliation(s)
- Brian T Moy
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Jonathan Wilmot
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030-8074, USA
| | - Enrique Ballesteros
- Department of Pathology, University of Connecticut Health Center, Farmington, CT, USA
| | - Faripour Forouhar
- Department of Pathology, University of Connecticut Health Center, Farmington, CT, USA
| | - Haleh Vaziri
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030-8074, USA.
| |
Collapse
|
46
|
Yamada S, Koshikawa Y, Minami N, Honzawa Y, Matsuura M, Nakase H. Ileal follicular lymphoma with atypical endoscopic findings. Endosc Int Open 2016; 4:E323-5. [PMID: 27004251 PMCID: PMC4798843 DOI: 10.1055/s-0042-100721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 72-year-old woman presented with symptomatic anemia without abdominal symptoms. She had no history of abdominal surgery or use of non-steroidal anti-inflammatory drugs. Enhanced computed tomography of the abdomen revealed swelling of multiple intraperitoneal lymph nodes and a high density of mesenteric adipose tissue. Fluorodeoxyglucose (FDG-) positron emission tomography showed high FDG accumulation at the intraperitoneal lymph nodes. Double-balloon enteroscopy detected severe stenosis with an annular ulcer in the lower ileum. She was diagnosed with ileal follicular lymphoma based on histologic examination and fluorescence in situ hybridization analysis of the biopsy specimen. The ileal ulcer was successfully treated by chemotherapy with rituximab and bendamustine for 1 year. We strongly recommend consideration of gastrointestinal follicular lymphoma in the differential diagnosis of annular ulcers in the small intestine.
Collapse
Affiliation(s)
- Satoshi Yamada
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yorimitsu Koshikawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Minami
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Honzawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Corresponding author Hiroshi Nakase, MD, PhD Department of Gastroenterology and HepatologyGraduate School of MedicineKyoto University54 Kawahara-choShogoinSakyo-kuKyoto606-8507Japan+81-75-7514303
| |
Collapse
|
47
|
Tari A, Asaoku H, Takata K, Fujimori S, Tanaka S, Fujihara M, Koga T, Yoshino T. The role of "watch and wait" in intestinal follicular lymphoma in rituximab era. Scand J Gastroenterol 2016; 51:321-8. [PMID: 26382560 DOI: 10.3109/00365521.2015.1087589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There is no consensus regarding the best treatment for intestinal follicular lymphoma (FL). We used "watch and wait" for patients with intestinal FL with low-tumor-burden (LTB) criteria and without mass formation causing bowel obstruction. We investigated the overall survival (OS) and time to treatment required (TTR). METHODS Thirty-three intestinal FL patients [clinical stage (CS) I:16, II1:0, II2:7, IV:10; median observation period: 45.5 months, range: 13-110 months] were diagnosed via endoscopy. Detailed clinical and pathological examinations were performed, and neoplastic process behavior was monitored. RESULTS All of the 33 patients were WHO grade 1. FL lesions in the digestive tract were found frequently in the second-fourth portion of the duodenum in 91% of the patients; 87% of those patients had lesions in a broader area including the small intestine. Two patients had an enlargement of the area of the lesions and a worsening of the macroscopic findings. Three patients had CS progression; however, these remained within the indication for "watch and wait." Two patients with transformation into diffuse large B-cell lymphoma received rituximab and chemotherapy, which led to complete remission. The OS was 100%. The time to treatment required (TTR) was 49 months in one patient and 37 months in one patient. CONCLUSION Intestinal FL in CS I-IV with broad infiltration of the digestive tract meeting the criteria for LTB had a remarkably slow course. This study suggests that "watch and wait" is appropriate for the treatment of LTB intestinal FL even in the era of rituximab.
Collapse
Affiliation(s)
| | - Hideki Asaoku
- b Department of Clinical Laboratory , Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital , Hiroshima , Japan
| | - Katsuyoshi Takata
- c Department of Pathology , Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences , Okayama , Japan
| | - Shunji Fujimori
- d Department of Gastroenterology , Chiba Hokusou Hospital, Nippon Medical School , Chiba , Japan
| | - Shinji Tanaka
- e Department of Endoscopy , Hiroshima University Hospital , Hiroshima , Japan
| | - Megumu Fujihara
- f Department of Pathology , Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital , Hiroshima , Japan , and
| | - Tadashi Koga
- g CPC Clinical Trial Hospital , Kagoshima , Japan
| | - Tadashi Yoshino
- c Department of Pathology , Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences , Okayama , Japan
| |
Collapse
|
48
|
Iwamuro M, Kondo E, Takata K, Yoshino T, Okada H. Diagnosis of follicular lymphoma of the gastrointestinal tract: A better initial diagnostic workup. World J Gastroenterol 2016; 22:1674-83. [PMID: 26819532 PMCID: PMC4721998 DOI: 10.3748/wjg.v22.i4.1674] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/28/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023] Open
Abstract
Due to an increasing incidence and more frequent recognition by endoscopists, gastrointestinal follicular lymphoma has been established as a variant of follicular lymphoma. However, due to its rarity, there are no established guidelines on the optimal diagnostic strategy for patients with primary gastrointestinal follicular lymphoma or secondary gastrointestinal involvement of systemic follicular lymphoma. This review offers an overview and pitfalls to avoid during the initial diagnostic workup of this disease entity. Previously reported case reports, case series, and retrospective studies are reviewed and focus on the disease's endoscopic and histological features, the roles of computed tomography and positron emission tomography scanning, the clinical utility of the soluble interleukin-2 receptor, and the possible pathogenesis.
Collapse
|
49
|
Lewis RB, Mehrotra AK, Rodríguez P, Manning MA, Levine MS. From the radiologic pathology archives: gastrointestinal lymphoma: radiologic and pathologic findings. Radiographics 2015; 34:1934-53. [PMID: 25384294 DOI: 10.1148/rg.347140148] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gastrointestinal (GI) lymphoma encompasses a heterogeneous group of neoplasms that have a common lymphoid origin but variable pathologic and imaging features. Extranodal marginal zone B-cell lymphoma (ENMZL) and diffuse large B-cell lymphoma (DLBCL) are the most common. ENMZL usually occurs in the stomach, where it is associated with chronic infection by Helicobacter pylori, and is typically a superficial spreading lesion that causes mucosal nodularity or ulceration and mild wall thickening. DLBCL may arise de novo or from transformation of ENMZL or other low-grade lymphomas. This form of lymphoma produces extensive wall thickening or a bulky mass, but obstruction is uncommon. Mantle cell lymphoma is the classic cause of lymphomatous polyposis, but multiple polyps or nodules can also be seen with ENMZL and follicular lymphoma. Burkitt lymphoma is usually characterized by an ileocecal mass or wall thickening in the terminal ileum in young children, often in the setting of widespread disease. Primary GI Hodgkin lymphoma, which is rare, may be manifested by a variety of findings, though stenosis is more common than with non-Hodgkin lymphoma. Enteropathy-associated T-cell lymphoma is frequently associated with celiac disease and is characterized by wall thickening, ulceration, and even perforation of the jejunum. Accurate radiologic diagnosis of GI lymphoma requires a multifactorial approach based on the clinical findings, site of involvement, imaging findings, and associated complications.
Collapse
Affiliation(s)
- Rachel B Lewis
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (R.B.L., M.A.M.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (R.B.L.); the Joint Pathology Center, Silver Spring, Md (A.K.M.); Department of Radiology, La Princesa University Hospital, Madrid, Spain (P.R.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (M.A.M.); and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | | | | | | | | |
Collapse
|
50
|
Vetro C, Bonanno G, Giulietti G, Romano A, Conticello C, Chiarenza A, Spina P, Coppolino F, Cunsolo R, Raimondo FD. Rare gastrointestinal lymphomas: The endoscopic investigation. World J Gastrointest Endosc 2015; 7:928-949. [PMID: 26265987 PMCID: PMC4530327 DOI: 10.4253/wjge.v7.i10.928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/01/2015] [Accepted: 07/09/2015] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease.
Collapse
|