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Case Reports
. 2014 Nov;93(26):e165.
doi: 10.1097/MD.0000000000000165.

A case report of the histologic transformation of primary follicular lymphoma of the duodenum

Shintaro Akiyama  1 , Koji Izutsu, Yasunori Ota, Tsunao Imamura, Osamu Ogawa, Atsushi Wake, Kazuo Takeuchi
Affiliations
Case Reports

A case report of the histologic transformation of primary follicular lymphoma of the duodenum

Shintaro Akiyama et al. Medicine (Baltimore). 2014 Nov.

Abstract

A 46-year-old woman underwent upper endoscopy for evaluation of anemia, which revealed whitish granules at the duodenal papilla, diagnosed as duodenal follicular lymphoma (DFL) by biopsy. Computed tomography and abdominal ultrasonography revealed that follicular lymphoma was confined to the duodenum. Seven years after the diagnosis, fluorine-18 fluorodeoxyglucose positron emission tomography scanning revealed multiple lesions including in bone marrow and lymph nodes. Bone marrow biopsy of the right iliac bone revealed diffuse large B-cell lymphoma, indicating systemic dissemination and histologic transformation of the DFL. The patient responded to chemotherapy and has been progression-free for 2.5 years. Although DFL is usually indolent even without any treatment, systemic dissemination with histologic transformation can occur. This case suggests that the life-time follow-up that is usually done for patients with nodal follicular lymphoma should be provided to patients with DFL.

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Conflict of interest statement

All authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
The series of endoscopic findings. At diagnosis of follicular lymphoma, the side-viewing endoscope revealed whitish granules around Vater papilla (white arrow) (A). At the time of transformation, whitish granules at Vater papilla increased in number and clustered together at Vater papilla (white arrow) (B). After 6 cycles of chemotherapy, the number of whitish granules decreased dramatically (white arrow) (C).
FIGURE 2
FIGURE 2
Endoscopic biopsy of granules around Vater papilla revealed the balloon-like villous hypertrophy caused by extrafollicular lymphoma cells (HE staining, Scale bar: 250 μm) (A). Biopsy of right iliac bone marrow showed sheets of large B cells (centroblasts), suggesting histologic transformation of follicular lymphoma into diffuse large B-cell lymphoma. Normal hematopoietic cells were replaced by lymphoma cells (HE staining, Scale bar: 50 μm) (B).
FIGURE 3
FIGURE 3
The result of 18F-FDG-PET scanning at transformation. 18F-FDG accumulated in the iliac bone, left pubic bone, thoracic vertebrae, right neck and flank, and right iliac lymph nodes. Red signals indicate accumulation of 18F-FDG, suggesting high tumor proliferation. The maximum standardized uptake value was 18.7 in the right iliac bone. (coronal view [A], sagittal view[B]). 18F-FDG-PET = fluorine-18 fluorodeoxyglucose positron emission tomography.
See this image and copyright information in PMC

References

    1. Schmatz AI, Streubel B, Kretschmer-Chott E, et al. Primary follicular lymphoma of the duodenum is a distinct mucosal/submucosal variant of follicular lymphoma: a retrospective study of 63 cases. J Clin Oncol 2011; 29:1445–1451. - PubMed
    1. Gallagher CJ, Gregory WM, Jones AE, et al. Follicular lymphoma: prognostic factors for response and survival. J Clin Oncol 1986; 4:1470–1480. - PubMed
    1. Montoro S, Davies AJ, Matthews J, et al. Risk and clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma. J Clin Oncol 2007; 25:2426–2433. - PubMed
    1. Takata K, Okada H, Ohmiya N, et al. Primary gastrointestinal follicular lymphoma involving the duodenal second portion is a distinct entity: a multicenter, retrospective analysis in Japan. Cancer Sci 2011; 102:1532–1536. - PubMed
    1. Takata K, Tanino M, Ennishi D, et al. Duodenal follicular lymphoma: comprehensive gene expression analysis with insights into pathogenesis. Cancer Sci 2014; 105:608–615. - PMC - PubMed

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