MALT Lymphoma of the Terminal Ileum
MALT Lymphoma of the Terminal Ileum
A woman, aged 61, had a colonoscopy because of a positive result from a fecal occult blood test. No abnormalities were detected in the colon but endoscopic examination of the terminal ileum showed multiple polypoid lesions (Fig. 1). Indigo carmine dye was then sprayed over the area to determine the presence or absence of intestinal villi. No villi were seen (Fig. 2). In contrast, nodules in the terminal ileum associated with lymphoid hyperplasia have normal villi on the mucosal surface as shown in the upper left panel. Biopsies revealed a diffuse infiltrate of small centrocyte-like cells and lymphoepithelial lesions. Immunohistochemical stains showed that the atypical cells were positive for CD20 and CD79a but negative for CD3, CD5, CD10 and cyclin D1. A computed tomography scan of the abdomen showed mesenteric lymphadenopathy around the terminal ileum. A positron emission tomography scan using fluorine-fluorodeoxyglucose was also abnormal with significant accumulation in the right lower quadrant of the abdomen. The patient was diagnosed as having an extranodal, marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT), at stage II in the revised European-American lymphoma classification.
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Figure1.
(Enlarge Image)
Figure 2.
The term MALT lymphoma has been used to describe a marginal zone B-cell lymphoma derived from gastrointestinal lymphoid tissue. In the stomach, MALT lymphoma is strongly associated with Helicobacter pylori. MALT lymphomas are rare in other regions of the gastrointestinal tract and there are only isolated reports of endoscopic features. A particular characteristic is the disappearance of intestinal villi, perhaps because lymphoma cells disturb the differentiation or migration of cells that arise from the intestinal crypts. As certain microorganisms may be involved in the development of MALT lymphomas of the small bowel, the patient was treated with antibiotics for 1 week. However, the appearance of the lymphoma was unchanged on follow-up colonoscopy and the patient was subsequently treated by chemotherapy. MALT lymphomas of the small bowel have a similar indolent course to MALT lymphomas of the stomach, but predisposing factors are less clear and there is debate about the relative merits of surgery and chemotherapy.
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A woman, aged 61, had a colonoscopy because of a positive result from a fecal occult blood test. No abnormalities were detected in the colon but endoscopic examination of the terminal ileum showed multiple polypoid lesions (Fig. 1). Indigo carmine dye was then sprayed over the area to determine the presence or absence of intestinal villi. No villi were seen (Fig. 2). In contrast, nodules in the terminal ileum associated with lymphoid hyperplasia have normal villi on the mucosal surface as shown in the upper left panel. Biopsies revealed a diffuse infiltrate of small centrocyte-like cells and lymphoepithelial lesions. Immunohistochemical stains showed that the atypical cells were positive for CD20 and CD79a but negative for CD3, CD5, CD10 and cyclin D1. A computed tomography scan of the abdomen showed mesenteric lymphadenopathy around the terminal ileum. A positron emission tomography scan using fluorine-fluorodeoxyglucose was also abnormal with significant accumulation in the right lower quadrant of the abdomen. The patient was diagnosed as having an extranodal, marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT), at stage II in the revised European-American lymphoma classification.
(Enlarge Image)
Figure1.
(Enlarge Image)
Figure 2.
The term MALT lymphoma has been used to describe a marginal zone B-cell lymphoma derived from gastrointestinal lymphoid tissue. In the stomach, MALT lymphoma is strongly associated with Helicobacter pylori. MALT lymphomas are rare in other regions of the gastrointestinal tract and there are only isolated reports of endoscopic features. A particular characteristic is the disappearance of intestinal villi, perhaps because lymphoma cells disturb the differentiation or migration of cells that arise from the intestinal crypts. As certain microorganisms may be involved in the development of MALT lymphomas of the small bowel, the patient was treated with antibiotics for 1 week. However, the appearance of the lymphoma was unchanged on follow-up colonoscopy and the patient was subsequently treated by chemotherapy. MALT lymphomas of the small bowel have a similar indolent course to MALT lymphomas of the stomach, but predisposing factors are less clear and there is debate about the relative merits of surgery and chemotherapy.
CLICK HERE for subscription information about this journal.
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