Diagnosis of follicular lymphoma of the gastrointestinal tract: A better initial diagnostic workup

Abstract

Due to an increasing incidence and more frequent recognition by endoscopists, gastrointestinal follicular lymphoma has been established as a variant of follicular lymphoma. However, due to its rarity, there are no established guidelines on the optimal diagnostic strategy for patients with primary gastrointestinal follicular lymphoma or secondary gastrointestinal involvement of systemic follicular lymphoma. This review offers an overview and pitfalls to avoid during the initial diagnostic workup of this disease entity. Previously reported case reports, case series, and retrospective studies are reviewed and focus on the disease's endoscopic and histological features, the roles of computed tomography and positron emission tomography scanning, the clinical utility of the soluble interleukin-2 receptor, and the possible pathogenesis.

Keywords: Duodenal neoplasms; Follicular lymphoma; Gastrointestinal endoscopy; Gastrointestinal lymphoma; Intestinal neoplasms.

Figure 1

Endoscopic features of intestinal follicular lymphoma in a 63-year-old woman. A: This case was diagnosed as follicular lymphoma with duodenal and jejunal lesions, and mesenteric lymph node involvement. The duodenal lesions are observed as multiple whitish nodules; B: Magnifying observation reveals opaque white depositions; C: Narrow-band imaging visualizes dilated microvessels on the surface of the white depositions; D: Video capsule enteroscopy shows multiple whitish granules in the jejunum; E: Double-balloon enteroscopy images of a jejunal lesion.

Figure 2

Pathological images (the same case shown in Figure 1). A: Neoplastic follicles are seen in the duodenal villi (hematoxylin and eosin staining, × 10); B: The lymphoma cells are composed of small- to medium-sized lymphoid cells (hematoxylin and eosin staining, × 40); C: The lymphoma cells are negative for CD3 (× 10); D: The lymphoma cells are positive for CD20 (× 10); E: The lymphoma cells are positive for CD10 (× 10); F: The lymphoma cells are positive for BCL2 (× 10).