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Small follicular lymphoma arising near the ampulla of vater

A distinct subtype of duodenal lymphoma?

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Abstract

A 49-yr-old Japanese woman underwent upper gastrointestinal endoscopy because of nonspecific dyspepsia. Endoscopy revealed a flat elevated lesion about 15 mm in diameter adjacent to the duodenal papilla, the surface of which was uneven and covered with whitish granules. Based on the results of histological examination with immunohistochemistry (positive for CD10, CD20, CD79a, and bcl-2 protein, negative for CD5 and cyclin D1), a diagnosis of grade 1/3 follicular lymphoma was established. Systemic staging examinations suggested the lymphoma was restricted to the mucosa and superficial portion of the submucosa in the duodenal wall. The patient was treated with a combination of CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and monoclonal anti-CD20 antibody (rituximab), in addition to radiotherapy. After six courses of this combination chemotherapy, complete regression of the lymphoma was observed. Although reports of small duodenal lymphoma (<20 mm or localized to the mucosa or submucosa) are extremely rare, the features of this case are characteristic of small duodenal lymphoma in terms of evolution around the ampulla of Vater, low-grade follicular type, occurrence in a women, occurrence in the fourth decade of life, and favorable outcome, and this type of tumor may need to be distinguished by pathogenesis and clinical behavior from various other gastrointestinal lymphomas.

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References

  1. Evans LS, Hancock BW. Non-Hodgkin lymphoma. Lancet 2003;362:139–146.

    Article  PubMed  CAS  Google Scholar 

  2. Damaj G, Verkarre V, Delmer A, et al. Primary follicular lymphoma of the gastrointestinal tract: a study of 25 cases and a literature review. Ann Oncol 2003;14:623–629.

    Article  PubMed  CAS  Google Scholar 

  3. Muchmore JH, Haddad CG, Goldwag S. Primary non-Hodgkin’s lymphoma of the duodenum. Am Surg 1994;60:924–928.

    Google Scholar 

  4. Amer MH, El-Akkad S. Gastrointestinal lymphoma in adults: clinical features and management of 300 cases. Gastroenterology 1994;106:846–858.

    Google Scholar 

  5. Yoshino T, Miyake K, Ichimura K, et al. Increased incidence of follicular lymphoma in the duodenum. Am J Surg Pathol 2000;24:688–693.

    Article  PubMed  CAS  Google Scholar 

  6. Nakamura S, Matsumoto T, Takeshita M, et al. A clinicopathologic study of primary small intestine lymphoma: prognostic significance of mucosa-associated lymphoid tissue-derived lymphoma. Cancer 2000;88:286–294.

    Article  PubMed  CAS  Google Scholar 

  7. Nadal E, Martinez A, Jiménez M, et al. Primary follicular lymphoma arising in the ampulla of Vater. Ann Hematol 2002;81:228–231.

    Article  PubMed  CAS  Google Scholar 

  8. Misdraji J, del Castillo CF, Ferry JA. Follicle center lymphoma of the ampulla of Vater presenting with jaundice. report of a case. Am J Surg Pathol 1997;21:484–488.

    Article  PubMed  CAS  Google Scholar 

  9. Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non-Hodgkin’s lymphoma: I. anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001;19:3861–3873.

    PubMed  CAS  Google Scholar 

  10. LeBrun DP, Kamel OW, Cleary ML, Dorfman RF, Warnke RA. Follicular lymphomas of the gastrointestinal tract. pathologic features in 31 cases and bcl-2 oncogenic protein expression. Am J Pathol 1992;140:1327–1335.

    PubMed  CAS  Google Scholar 

  11. Shia J, Teruya-Feldstein J, Pan D, et al. Primary follicular lymphoma of the gastrointestinal tract: a clinical and pathologic study of 26 cases. Am J Surg Pathol 2002;26:216–224.

    Article  PubMed  Google Scholar 

  12. Jaffe ES, Harris NL, Vardiman JW, Stein H. Pathology and genetics: neoplasms of the haematopoietic and lymphoid tissues, in World Health Organization Classification of Tumours. Kleihaus P, and Sobin L, eds. IARC Press, Lyon, 2001.

    Google Scholar 

  13. Rohatiner A, d’Amore F, Coiffier B, et al. Report on a workshop convened to discuss the pathological and staging classification of gastrointestinal tract lymphoma. Ann Oncol 1994;5:397–400.

    Google Scholar 

  14. Czuczman MS, Grillo-López AJ, White CA, et al. Treatment of patients with low-grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy. J Clin Oncol 1999;17:268–276.

    PubMed  CAS  Google Scholar 

  15. Tanaka S, Onoue G, Fujimoto T, et al. A case of primary follicular lymphoma in the duodenum confined to the mucosal layer. J Clin Gastroenterol 2002;35:285–286.

    Article  PubMed  Google Scholar 

  16. Matsuzawa M, Shimodaira K, Nakamura N, et al. A case of primary follicular lymphoma of the duodenum with BCL-2 gene rearrangement. J Gastroenterol 2003;38:512–513.

    Article  PubMed  Google Scholar 

  17. Shibuki S, Watanabe H, Fujita N. Early non-Hodgkin’s lymphoma of the duodenal bulb, report of a case. I to Cho (Stomach and Intestine) 1988;23:1363–1367. (In Japanese, abstract in English.)

    Google Scholar 

  18. Miyagishima T, Ohmura T, Ohnishi S, et al. A case of early non-Hodgkin lymphoma of the duodenum. Gastroenterol Endosc 1995;37:2761–2767. (In Japanese, abstract in English.)

    Google Scholar 

  19. Katsuki S, Nojiri S, Ohmi R, et al. Primary early follicular lymphoma of the duodenum, report of a case. I to Cho (Stomach and Intestine) 1988;33:1665–1670. (In Japanese, abstract in English.)

    Google Scholar 

  20. Torishima R, Nagai T, Nakashima H, et al. A case of primary early malignant lymphoma in the second portion of the duodenum. Gastroenterol Endosc 2001;43:1842–1846. (In Japanese, abstract in English.)

    Google Scholar 

  21. Kuwabara K, Yamada H, Ishida H, et al. A case report of the malignant lymphoma of the duodenum. Prog Dig Endosc 2002;60:48–49. (In Japanese, abstract in English.)

    Google Scholar 

  22. Takikawa H, Hiki N, Tatsutomi Y, et al. A case of follicular lymphoma in the duodenum successfully treated with surgical resection after eradication of Helicobacter pylori. Prog Dig Endosc 2002;61:98–99. (In Japanese, abstract in English.)

    Google Scholar 

  23. Sasaki M, Yakushijin Y, Hato T, Kushida Y, Shiraishi T, Shiraishi S. A case of follicular lymphoma of the duodenum treated by anti CD20 antibody (rituximab). Gastroenterol Endosc 2004;46:151–157. (In Japanese, abstract in English.)

    Google Scholar 

  24. Ross RK, Hartnett NM, Bernstein L, Henderson BE. Epidemiology of adenocarcinomas of the small intestine: is bile a small bowel carcinogen? Br J Cancer 1991;63:143–145.

    PubMed  CAS  Google Scholar 

  25. Tang Z, Jing W, Lindeman N, Harris NL, Ferry JA. One patient, two lymphomas. Simultaneous primary gastric marginal zone lymphoma and primary duodenal follicular lymphoma. Arch Pathol Lab Med 2004;128:1035–1038.

    PubMed  Google Scholar 

  26. Bende RJ, Smit LA, Bossenbroek JG, et al. Primary follicular lymphoma of the small intestine. α4β7 expression and immunoglobulin configuration suggest an origin from local antigen-experienced B cells. Am J Pathol 2003;162:105–113.

    PubMed  CAS  Google Scholar 

  27. Toyoda H, Yamaguchi M, Nakamura S, et al. Regression of primary lymphoma of the ampulla of Vater after eradication of Helicobacter pylori. Gastrointest Endosc 2001;54:92–96.

    Article  PubMed  CAS  Google Scholar 

  28. Al-Salman J, Salib H, Boonswang P. Successful treatment of gastrointestinal follicular lymphoma with rituxan and combination chemotherapy. Med Oncol 2001;18:277–283.

    Article  PubMed  CAS  Google Scholar 

  29. Ahmed S, Singh A, Krauss J, Wentz T, Gunaratnam NT. Successful treatment of refractory low grade duodenal lymphoma with rituximab, an anti-cd20 monoclonal antibody. Am J Clin Oncol 2003;26:408–410.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Takara-machi 13-1, 920-8641, Kanazawa, Japan

    Takahiro Zenda MD & Takaharu Masunaga

  2. Department of Pathology, KKR Hokuriku Hospital, Izumigaoka 2-13-43, 921-8035, Kanazawa, Japan

    Bungo Fuwa

  3. Department of Gastroenterology, Graduate School of Medical Science, Kanazawa University, Takara-machi 13-1, 920-8641, Kanazawa, Japan

    Toshihide Okada

  4. Department of Hematology, Graduate School of Medical Science, Kanazawa University, Takara-machi 13-1, 920-8641, Kanazawa, Japan

    Yasuo Ontachi, Yukio Kondo & Shinji Nakao

  5. Department of Pathology, Graduate School of Medical Science, Kanazawa University, Takara-machi 13-1, 920-8641, Kanazawa, Japan

    Hiroshi Minato

Authors
  1. Takahiro Zenda MD
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  2. Takaharu Masunaga
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  3. Bungo Fuwa
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  4. Toshihide Okada
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  5. Yasuo Ontachi
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  6. Yukio Kondo
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  7. Shinji Nakao
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Correspondence to Takahiro Zenda MD.

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Zenda, T., Masunaga, T., Fuwa, B. et al. Small follicular lymphoma arising near the ampulla of vater. Int J Gastrointest Canc 36, 113–119 (2005). https://doi.org/10.1385/IJGC:36:2:113

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