Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography
A previously healthy 51-year-old man visited our hospital for a routine check-up. Physical examination and routine hematological and other laboratory studies were normal. Endoscopy showed a whitish granular lesion on duodenum third portion (). EUS showed superficially spreading and hypoechoic lesion that was similar to the first case (). Histological examination of the stomach was positive for H. pylori. Histology of the duodenal infiltration was compatible with MALT lymphoma: presence of lymphoepithelial lesions and diffuse infiltration of small lymphoid cells with the monoclonality of immunoglobulin heavy chain and positivity for CD20 (). Chest CT scan showed approximately 0.6-cm sized left supraclavicular lymph node enlargement. Abdominal CT disclosed multiple lymphadenopathy approximately 1 cm in diameter at aortocaval and mesenteric lymph nodes. The patient was classified as having stage IIIE MALT lymphoma, so we administered systemic cyclophosphamide, vincristine, prednisone, and rituximab every 3 weeks. The patient achieved complete remission after six courses of chemotherapy. A follow-up endoscopy after the chemotherapy showed complete regression of the duodenal MALT lymphoma and the enlarged lymph node disappeared on CT scan. The patient was followed up without recurrence for about 6 months.