Primary Intestinal Follicular Lymphoma Diagnosed by Double Balloon Endoscopy: Endoscopic Features and Treatment Outcomes

Kinichi Hotta, Toshimi Mitsuishi, Yoshinori Miyata, Akihisa Tomori

Abstract


Objective: Little is known about the endoscopic features and clinical significance of small bowel (SB) lesions in primary intestinal follicular lymphoma (IFL). This study aimed to describe, based on a case series, detailed endoscopic features of SB lesions in IFLs and the relationship between clinical and histological stages.
Methods: This retrospective study included 14 patients (8 females, median age, 61.5 years) newly diagnosed with IFL of SB. All patients underwent double balloon endoscopy (DBE), with both anterograde and retrograde approaches.
Results: The distribution of IFLs in the GI tract were stomach 7%(1/14), duodenal bulb 7% (1/14), second part of the duodenum 93% (13/14), third part of the duodenum 86% (12/14), jejunum 93% (13/14), and ileum 43% (6/14). No colorectal lesions were detected. Multiple granules were the most frequently detected lesion, and were found in all patients. Nodule/mass lesions were detected in 5 patients. Nodule/mass lesions and ileal lesions were highly associated with the Lugano international classification. Eleven of 14 patients received chemotherapy plus Rituximab. Ten of 11 patients achieved complete response (CR). One patient achieved partial response (PR), but later exhibited disease progression. Four patients experienced grade 3 or 4 neutropenia, but all recovered without permanent side effects. One patient that achieved CR exhibited progressive disease after 54 months. All patients survived for a median of 35 months.
Conclusions: DBE was necessary for the precise diagnosis of IFL involving the SB. Endoscopic features included a nodule/mass and ileal lesions, which were related to the clinical stage.


Keywords


follicular lymphoma, gastrointestinal tract, small bowel, double balloon endoscopy, rituximab

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References


[1] Armitage, J. O., & Weisenburger, D. D. (1998). New approach to classifying non-Hodgkin’s lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin’s Lymphoma Classification Project. J. Clin Oncol, 16, 2780-95.

[2]. Nakamura, S., Matsumoto, T., & Takeshita, M. et al. (2000). A clinicopathologic study of primary small intestine lymphoma: Prognostic significance of mucosa-associated lymphoid tissue-derived lymphoma. Cancer, 88, 286-94.

[3] Yoshino, T., Miyake, K., & Ichimura, K, et al. (2000). Increased incidence of follicular lymphoma in the duodenum. Am J Surg Pathol, 24, 688-93.

[4] Yamamoto, S., Nakase, H., & Yamashita, K. et al. (2010). Gastrointestinal follicular lymphoma: Review of the literature. J Gastroenterol, 45, 370-88.

[5]. Nakamura, S., Matsumoto, T., & Umeno, J., et al. (2007). Endoscopic features of intestinal follicular lymphoma: The value of double-balloon enteroscopy. Endoscopy, 39 (Suppl1), E26-7.

[6] Higuchi, K., Komatsu, K., & Wakamatsu, H., et al. (2007). Small intestinal follicular lymphoma with multiple tumor formations diagnosed by double-balloon enteroscopy. Intern Med, 46, 705-9.

[7] Akamatsu, T., Kaneko, Y., & Ota, H., et al. (2010). Usefulness of double balloon enteroscopy and video capsule endoscopy for the diagnosis and management of primary follicular lymphoma of the gastrointestinal tract in its early stages. Dig Endosc, 22, 33-8.

[8] Mann, R. B., & Berard, C. W. (1983). Criteria for the cytologic subclassification of follicular lymphomas: A proposed alternative method. Hematol Oncol, 1, 187-92.

[9] Rohatiner, A, d’Amore, F., & Coiffier, B., et al. (1994). Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol, 5, 397-400.

[10] Czuczman, M. S., Weaver, R., & Alkuzweny, B., et al. (2004). Prolonged clinical and molecular remission in patients with low-grade or follicular non-Hodgkin’s lymphoma treated with rituximab plus CHOP chemotherapy: 9-year follow-up. J Clin Onco, 22, 4711-6.

[11] Hiddemann, W., Kneba, M., & Dreyling, M., et al. (2005). Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: Results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood, 106, 3725-32.

[12] Therasse, P., Arbuck, S. G., Eisenhauer, E. A., et al. (2000). New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst, 92, 205-16.

[13] Damaj, G., Verkarre, V., & Delmer, A., et al. (2003). Primary follicular lymphoma of the gastrointestinal tract: a study of 25 cases and a literature review. Ann Oncol, 14, 623-9.

[14] Huang, W. T., Hsu, Y. H., & Yang, S. F., et al. (2008). Primary gastrointestinal follicular lymphoma: A clinicopathologic study of 13 cases from Taiwan. J Clin Gastroenterol, 42, 997-1002.

[15] Shia, J, Teruya-Feldstein, J., & Pan, D., et al. (2003). Primary follicular lymphoma of the gastrointestinal tract: a clinical and pathologic study of 26 cases. Am J Surg Pathol, 26, 216-24.

[16] Tari, A., Asaoku, H., & Kunihiro, M., et al. (2011). Clinical features of gastrointestinal follicular lymphoma: comparison with nodal follicular lymphoma and gastrointestinal MALT lymphoma. Digestion, 83, 191-7.

[17] Nadal, E., Martinez, A., & Jimenez, M., et al. (2002). Primary follicular lymphoma arising in the ampulla of Vater. Ann Hematol, 81, 228-31.

[18] Sapoznikov, B., Morgenstern, S., & Raanani, P., et al. (2007). Follicular lymphoma with extensive gastrointestinal tract involvement: Follow-up by capsule endoscopy. Dig Dis Sci, 52, 1031-5.

[19] Takata, K., Okada, H., & Ohmiya, N., et al. (2011). Primary gastrointestinal follicular lymphoma involving the duodenal second portion is a distinct entity: A multicenter, retrospective analysis in Japan. Cancer Sci 102,1532-6.

[20] Schmatz, A. I., Streubel, B., & Kretschmer-Chott , E., et al. (2011). Primary follicular lymphoma of the duodenum is a distinct mucosal/submucosal variant of follicular lymphoma: A retrospective study of 63 cases. J Clin Oncol, 29,1445-51.

[21] Kahl, B. (2012). Is there a role for “watch and wait” in follicular lymphoma in the rituximab era (pp.433-8)? Hematology Am Soc Hematol Educ Program.




DOI: http://dx.doi.org/10.3968/gh.v2i1.5234

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