Duodenal mucosa-associated lymphoid tissue lymphomas: two cases and the evaluation of endoscopic ultrasonography

Abstract

Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.

Keywords: Duodenum; Endosonography; Lymphoma, B-cell, marginal zone; Mucosa-associated lymphoid tissue.

Fig. 1

Pretreatment endoscopic and ultrasonographic images of case 1. (A) Endoscopic findings. A slightly depressed lesion was seen with fold clubbing and granular base on the duodenum blub (near superior descending angle). (B) Endoscopic ultrasonographic findings. Superficially spreading type hypoechoic lesion was seen with the wall thickening of the second layer and partial indentation of the third layer.

Fig. 2

Histopathology of the duodenal lesion of case 1. Lymphoepithelial lesions were seen with diffuse infiltration of small lymphoid cells (H&E stain, ×400).

Fig. 3

A follow-up endoscopic and ultrasonographic images after the eradication therapy of case 1. (A) The regression of granular base and fold clubbing was seen near superior descending angle. (B) The remission of wall thickening was seen on the second layer.

Fig. 4

Endoscopic and ultrasonographic images at the time of the detection of duodenal lesion in case 2. (A) Endoscopic findings. A whitish granular lesion was seen on the duodenum third portion. (B) Endoscopic ultrasonographic findings. Superficially spreading type hypoechoic lesions was seen with the wall thickening of the second layer and partial indentation of the third layer.

Fig. 5

Histopathology of the duodenal lesion of case 2. Lymphoepithelial lesions were seen with diffuse infiltration of small lymphoid cells (H&E stain, ×400).