Colonic mucosa-associated lymphoid tissue lymphoma: a case series

Clinical Characteristics and Long-Term Prognosis of Colorectal Mucosa-Associated Lymphoid Tissue Lymphoma According to the Endoscopic Classification and Treatment Modality: A Multicenter Study

Background/Objectives: The clinical characteristics of colorectal mucosa-associated lymphoid tissue (MALT) lymphoma remain poorly defined, and there is no standardized treatment for the disease. Therefore, we investigated the clinical characteristics of colorectal MALT lymphoma and its prognosis based on different treatment modalities. Methods: A retrospective analysis was performed on patients diagnosed with colorectal MALT lymphoma from 2003 to 2021 across six hospitals in Korea's Busan-Ulsan-Gyeongnam area. Macroscopic findings classified all cases into polyposis type, mass-forming type, subepithelial lesion type, and inflammatory type. Results: Fifty-one patients were enrolled. The median age was 59 years, and 27 patients (52.9%) were male. Five patients (9.8%) were stage IV at initial diagnosis. As for the endoscopic type, the polyposis type was the most common (39.2%). There was no statistically significant difference in disease progression according to the endoscopic type (p = 0.813). Three cases of disease progression were confirmed in stage I after treatment, and one of them died due to disease progression. No disease progression was identified in other stages. According to the treatment modality, disease progression was identified in 1 of 16 patients who underwent endoscopic resection and 2 of 16 patients who underwent chemotherapy. There was no disease progression in the observation group. However, there was no statistically significant difference in disease progression according to treatment modality (p = 0.889). Conclusions: Colorectal MALT lymphoma showed good prognosis regardless of the initial stage, endoscopic type, or treatment modality.

Transformed gastric mucosa-associated lymphoid tissue lymphoma originating in the colon and developing metachronously after Helicobacter pylori eradication: A case report

BACKGROUND

Helicobacter pylori (H. pylori) eradication treatment for primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma has already been established. However, t (11;18) (q21;q21)/API2-MALT1 translocation-positive lesions are a type of primary gastric MALT lymphoma in which a response to eradication treatment is difficult to achieve. In addition, trisomy 18 may be associated with diffuse large B-cell lymphoma (DLBCL) transformation of gastric MALT lymphoma.

CASE SUMMARY

A 66-year-old man was diagnosed with MALT lymphoma in the ascending colon by colonoscopy and biopsy. Two years later, esophagogastroduodenoscopy revealed chronic atrophic gastritis that was positive for H. pylori, and eradication treatment was administered. Two years and nine months later (at the age of 70), a new ulcerative lesion suggestive of MALT lymphoma appeared in the gastric body, and six months later, a similar lesion was also found in the fundus. One year later (4 years and 3 months after H. pylori eradication), at the age of 72, the lesion in the gastric body had become deeper and had propagated. A biopsy revealed a pathological diagnosis of DLBCL. Both MALT lymphoma lesions in the ascending colon and DLBCL lesions in the stomach were positive for the t (11;18) (q21;q21)/API2-MALT1 translocation, and trisomy 18q21 was also detected. After 6 courses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, all of the above lesions disappeared [complete remission (CR)], and CR has been maintained for more than 3 years. In addition, both the colonic and gastric lesions were proven to have the same clonality.

CONCLUSION

Because the patient had a MALT1 translocation with trisomy 18q21, it was thought that this gastric MALT lymphoma developed independently of H. pylori infection and progressed.

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue of the ileum in an adult presenting with intussusception: a case report and literature review

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL), also known as MALT lymphoma, is an extranodal multiorgan-invasive proliferative lymphoma composed of small B cells with variable morphology. It most commonly occurs in the digestive tract, with a high prevalence in the stomach, but EMZL originating in the small intestine is rare and lacks specificity in clinical manifestations, which makes it easy to be misdiagnosed. Herein, we report a rare case of small intestinal EMZL presentation as intussusception in a 32-year-old man. A colonoscopy performed at the local hospital revealed a pedicled polyp about 5 cm × 5 cm in size with a rough surface, and hyperemia was seen in the ileocecal region. He was admitted to our hospital for a polypectomy. A contrast-enhanced computed tomographic (CT) scan suggested ileocolic intussusception, which was subsequently confirmed by a colonoscopy in our hospital. Adult intussusception is relatively rare, with 90% of cases having a known causative mechanism and 40% of cases caused by primary or secondary malignancies. Therefore, we performed a laparoscopic-assisted right hemicolectomy for the patient. The resected specimen showed that the terminal ileum was intussuscepted into the ascending colon, and the intussusception was hyperemia and edema. A 2.5 cm × 2.5 cm × 1.5 cm mass was seen at the end of the intussusception. Postoperative pathology revealed that the mass was EMZL, partially transformed into a large B-cell lymphoma. The patient was transferred to the hematology department and completed a PET-CT showing postoperative manifestations of primary intestinal lymphoma, Lugano staging IE2. Although EMZL was an indolent lymphoma and the patient was in the early stages, the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen was given in view of the histological transformation. The patient is in regular follow-up. This was a rare case of small intestinal mass due to EMZL presented as intussusception in adults, which highlighted laparoscopic-assisted enterectomy as a potential therapeutic approach in the multidisciplinary collaborative therapy of small intestine EMZL.

Marginal zone lymphoma: 2023 update on diagnosis and management

DISEASE OVERVIEW

Marginal zone lymphomas (MZL) are collectively the second most common type of indolent lymphoma.

DIAGNOSIS

Three subtypes of MZL are recognized: splenic, extranodal, and nodal. The diagnosis is secured following biopsy of an involved nodal or extranodal site demonstrating a clonal B-cell infiltrate with CD5 and CD10 negative immunophenotype most common. Some cases will features IgM paraprotein, but MYD88 L256P mutations are less frequent than in Waldenstrom macroglobulinemia. Prognostication Several prognostic models have been developed, including the MALT-IPI and the MZL-IPI. The latter is broadly applicable across MZL subtypes and incorporates elevated serum LDH, anemia, lymphopenia, thrombocytopenia and nodal or disseminated subtypes as independent predictors of outcome.

TREATMENT

We discuss suggested approach to therapy for both early and advanced-stage disease, with reference to chemo-immunotherapy, radiotherapy, and emerging treatments in relapsed/refractory disease such as BTK inhibitors.

Primary rectal mucosa-associated lymphoid tissue lymphoma treated with only endoscopic submucosal dissection: A case report

BACKGROUND

Mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct subtype of non-Hodgkin B cell lymphoma that mostly involves the gastrointestinal tract. The stomach is the most commonly affected site whereas colorectal involvement occurs very rarely. Given its rarity, the management and clinical outcome of colorectal MALT lymphoma are not well established yet.

CASE SUMMARY

From the superficial capillary bed in the lower rectum. Endoscopic ultrasonography showed homogenous hypoechoic lesions in the deep mucosal layer. Endoscopic submucosal dissection (ESD) was done for accurate histologic diagnosis and treatment and both the rectal lesions were completely removed en bloc and subsequently diagnosed as primary rectal MALT lymphoma. Herein, we report a case of primary rectal MALT lymphoma in a 68-year-old woman that was treated by only ESD, and the 12-month follow-up revealed no tumour recurrence.

CONCLUSION

These results of our case and previous reports suggest that endoscopic resection alone may be a feasible and safe treatment for primary colorectal MALT lymphoma and allows organ preservation.

Rare primary rectal mucosa-associated lymphoid tissue lymphoma with curative resection by endoscopic submucosal dissection: A case report and review of literature

BACKGROUND

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurs in approximately 9% of non-Hodgkin B-cell lymphomas. The gastrointestinal tract is the most commonly affected site of the extranodal forms of primary non-Hodgkin’s lymphomas. However, it rarely occurs within the rectum, and at present, there is no consensus on its diagnosis and treatment at this site.

CASE SUMMARY

We report a rare laterally spreading tumour-like rectal MALT lymphoma case in which the diagnosis and the depth of infiltration were determined by magnifying endoscopy and ultrasonic endoscopy. Then, the lesion was en bloc resected by endoscopic submucosal dissection (ESD) alone. The lesion was confirmed as MALT lymphoma by haematoxylin and eosin staining, immunohistochemical staining and gene arrangement analysis. Surveillance exams have indicated a 2-year disease-free survival for this patient.

CONCLUSION

We report a rare primary rectal MALT lymphoma that was curable with resection by ESD. ESD is a safe and effective therapeutic option for rectal MALT lymphoma.

The Pillow Sign: Is It Always Benign?

Mucosa-associated lymphoid tissue (MALT) lymphoma is classically found in the stomach; however, in less common, cases can be found in extragastric locations. Colonic MALTomas are exceedingly rare and comprise a small group of extragastric cases. There is no standardized approach for optimal management of this disease. We report a case of a colonic MALT lymphoma found on colonoscopy that demonstrated the pillow sign and appearance of a benign lipoma. Despite antimicrobial and endoscopic therapy, the malignancy reoccurred in a patient with chronic hepatitis B, thereby precluding one of the mainstays of treatment, rituximab, until viral eradication.

Synchronous colonic mucosa-associated lymphoid tissue lymphoma found after surgery for adenocarcinoma: A case report and review of literature

BACKGROUND

Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of non-Hodgkin lymphoma that is mainly involved in the gastrointestinal tract. The synchronous occurrence of colonic MALT lymphoma and adenocarcinoma in the same patient is extremely rare. We here report a case of synchronous colonic MALT lymphoma found on surveillance colonoscopy five months after surgery and chemotherapy for sigmoid adenocarcinoma.

CASE SUMMARY

A 67-year-old man was admitted because of hematochezia for two months. Colonoscopy suggested a colonic tumor before hospitalization. Abdominal computed tomography (CT) revealed local thickening of the sigmoid colon. The patient underwent a left hemicolectomy with local lymph node dissection. The histopathology revealed moderately differentiated adenocarcinoma and partially mucinous adenocarcinoma. The pTNM stage was T3N1Mx. The patient received chemotherapy with six cycles of mFOLFOX6 after surgery. Colonoscopy was performed five months later and revealed single, flat, polypoid lesions of the colon 33 cm away from the anus. Subsequently, the patient underwent endoscopic mucosal resection for further diagnosis. The pathological diagnosis was MALT lymphoma. Positron emission tomography /CT suggested metastasis. The patient refused further treatment and died ten months later.

CONCLUSION

Colonic MALT lymphoma may occur after surgery and chemotherapy for adenocarcinoma as a synchronous malignancy. Regular surveillance colonoscopy and careful monitoring after surgery are critical.

Colonic Mucosa-associated Lymphoid Tissue Lymphoma Treated by Radiation Therapy: Report of a Case and Literature Review

Mucosa-associated lymphoid tissue (MALT) lymphoma predominantly involves the gastrointestinal tract, with the stomach being the most commonly affected site. Colonic involvement is quite rare. Hence, the etiology, clinical characteristics, treatment, and outcome of colonic MALT lymphoma are not well established. This paper reports a case of MALT lymphoma of the transverse colon, presenting as a subepithelial tumor in a 50-year-old woman. The patient received 3,060 cGy in 17 fractions with external beam radiation therapy for three weeks. At 2 months after radiation therapy, a colonoscopy examination revealed complete resolution and a scar change of the lesion. The follow-up at 24 months revealed no evidence of tumor recurrence after radiation therapy.