Magnifying Endoscopy for Intestinal Follicular Lymphoma Is Helpful for Prompt Diagnosis
A 57-year-old Japanese woman underwent postoperative surveillance esophagogastroduodenoscopy. She had a prior history of partial gastrectomy at the age of 54 due to advanced gastric cancer. Physical examination revealed no abnormalities, and there was no evidence of hepatosplenomegaly or peripheral lymphadenopathy. The patient had no abnormality on laboratory examinations including complete blood count, lactate dehydrogenase levels, and soluble interleukin-2 receptor levels. Endoscopic examination showed no recurrence of the gastric cancer but revealed two lesions in the duodenum (); these areas were composed of confluent whitish granules, rather than nodules or polyps, which are the typical findings of intestinal FL. Magnifying endoscopy () and endoscopy with indigo carmine contrast () revealed whitish enlarged villi. An elongated and coiled vascular pattern in the swollen villi was emphasized by magnifying narrow band imaging (). Based on these features, intestinal FL was highly suspected. In the biopsy specimens, small to medium-sized neoplastic lymphoid cells were shown to have formed lymphoid structures and infiltrated the villi (). Immunohistochemical study reinforced the diagnosis, with positivity for CD20, CD10 (), and B-cell lymphoma (BCL)-2 (). Dilated capillary vessels in the villi were also demonstrated by CD31 staining (). Computed tomography scanning of the neck, chest, abdomen, and pelvis showed neither remarkable lymphadenopathy nor gastrointestinal wall thickening including the duodenum. Consequently, we diagnosed the case as primary FL of the duodenum. The clinical stage was considered as stage I. The patient was referred to a tertiary referral center for further investigation and treatment.