Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025;11(1):25-0108.
doi: 10.70352/scrj.cr.25-0108. Epub 2025 Jun 18.

Two Cases of Small Intestinal Follicular Lymphoma Presenting with Intestinal Stricture

Akihiro Nakamura  1 , Syuichi Komori  1 , So Murai  2 , Shiori Shibata  1 , Hideyuki Oyama  1 , Kazuhiro Kijima  1 , Yoshikuni Harada  1 , Gaku Kigawa  1 , Takahiro Umemoto  1 , Takafumi Ogawa  2 , Kuniya Tanaka  1
Affiliations
Case Reports

Two Cases of Small Intestinal Follicular Lymphoma Presenting with Intestinal Stricture

Akihiro Nakamura et al. Surg Case Rep. 2025.

Abstract

Introduction: Primary gastrointestinal follicular lymphoma (FL) rarely causes intestinal stricture. We report two cases of small intestinal FL presenting with stricture.

Case presentation: Case 1: A 63-year-old man presented with small intestinal obstruction. CT demonstrated ileal wall thickening and enlarged lymph nodes. Partial ileal resection confirmed primary ileal FL, immunohistochemically positive for CD10, CD20, and BCL-2. Case 2: A 79-year-old woman with a 7-year history of jejunal strictures underwent right hemicolectomy for ascending colon cancer and partial jejunal resection. Pathologic examination showed concurrent jejunal FL and colon adenocarcinoma. Immunohistochemical findings were the same as in Case 1. In both patients, postoperative positron-emission tomography-CT showed no residual lymphoma. Both were monitored clinically without chemotherapy.

Conclusions: These cases highlight an unusual presentation of follicular lymphoma as a cause of intestinal stricture. Surgical resection provided diagnostic clarity and relief of symptoms. Postoperative treatment was tailored to individual patient characteristics and residual disease status.

Keywords: follicular lymphoma; lymphoma; obstruction; small intestine; stricture.

PubMed Disclaimer

Conflict of interest statement

All authors declare no competing interests for this article.

Figures

Fig. 1
Fig. 1. (A) Contrast-enhanced CT of the abdomen in case 1 showed thickening of the ileal wall with contrast effect, dilation of the proximal bowel (arrow), and enlarged lymph nodes near the ileal tract (arrowheads). (B) A small intestinal series performed using the ileus tube showed fully circumferential stricture extending for 18 mm (arrow).
Fig. 2
Fig. 2. (A) The specimen from the resected ileum showed circumferential wall thickening with ulcerative lesions (arrow). (B) HE staining viewed with a 2× objective lens showed nodular structures. Atypical lymphocytes infiltrated the serosal layers (arrow) and invaded the neural plexus (arrowheads). (C) HE staining (10× objective lens) showed proliferation of small- to medium-sized atypical lymphocytes. (D) HE staining (2× objective lens) showed an ulcerative lesion (arrows). (E) HE staining of nodules (2× objective lens). In panels (F–H), immunohistochemical analysis showed centers of nodules to be positive for Bcl-2, CD10, and CD20 respectively; 2× objective lens.
HE, hematoxylin-eosin
Fig. 3
Fig. 3. (A) Enteroscopy showed strictures in the jejunum. (B) Enteroscopy showed multiple erosions in the jejunum. (C) Small intestinal series performed using the ileus tube showed a stricture involving the entire circumference for a length of 16 mm (arrow).
Fig. 4
Fig. 4. (A) Noncontrast CT of the abdomen showed thickening of the wall of the ascending colon (arrow) and enlargement of surrounding lymph nodes (arrowheads). (B) Contrast CT of the abdomen showed enlarged jejunal mesenteric lymph nodes (arrows).
Fig. 5
Fig. 5. (A) The resected jejunal specimen showed circumferential wall thickening with ulcerative lesions and dilation of the proximal intestine (arrow). (B) HE staining, 2× objective lens: Nodular areas were observed. Atypical lymphocytes infiltrated serosal layers (arrows) and invaded the neural plexus (arrowheads). (C) HE staining, 10× objective lens: Proliferation of small-sized atypical lymphocytes was observed. (D) HE staining, 2× objective lens: Ulceration was observed (arrows). (E) HE staining, 2× objective lens showed centers of nodules. (F–H) Immunohistochemical analyses of the same field were positive for Bcl-2, CD10, and CD20 (F: Bcl-2 staining, 2× objective lens, G: CD10 staining, 2× objective lens, H: CD10 staining, 2× objective lens).
HE, hematoxylin-eosin
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Li Z, Chen X, Wang Z, et al. Clinicopathologic features and prognosis analysis of gastrointestinal follicular lymphoma: a multi-center study. Front Oncol 2022; 12: 841058.
    1. Marks E, Shi Y, Grashow R, et al. Characteristics, management and outcomes of gastrointestinal follicular lymphoma: a multi-institutional study. Leuk Lymphoma 2022; 63: 2908–16.
    1. Iwamuro M, Kondo E, Takata K, et al. Diagnosis of follicular lymphoma of the gastrointestinal tract: a better initial diagnostic workup. World J Gastroenterol 2016; 22: 1674–83. - PMC - PubMed
    1. Castro-Pochintesta BA, Ruano-Ravina A, Coupland SE, et al. Endoscopic features of gastrointestinal follicular lymphoma: systematic review and meta-analysis. United European Gastroenterol J 2021;781–90.
    1. Yamamoto E, Tomita N, Sakata S, et al. Long-term outcomes of patients with primary gastrointestinal follicular lymphoma treated with rituximab-based systemic immunochemotherapy. Hematol Oncol 2023; 41:90–8.

Publication types