Clinical course of duodenal mucosa-associated lymphoid tissue lymphoma: Comparison with gastric mucosa-associated lymphoid tissue lymphoma

Diagnosing Median Arcuate Ligament Syndrome in a Patient With a History of Duodenal Lymphoma: A Case Report

Median arcuate ligament syndrome (MALS) is a rare vascular disorder that leads to a constellation of nonspecific gastrointestinal symptoms. We present a case of a 60-year-old male with a history of duodenal lymphoma in remission, insulin-dependent diabetes mellitus, and longstanding gastrointestinal symptoms, who developed worsening postprandial epigastric pain over eight months. Despite extensive evaluations including esophagogastroduodenoscopy (EGD), gastric emptying studies, and a hepatobiliary iminodiacetic acid (HIDA) scan, no definitive cause was identified. A computed tomography (CT) angiogram revealed anterior superior indentation of the proximal celiac artery by the diaphragmatic crus and post-stenotic dilation, consistent with MALS. The patient underwent laparoscopic median arcuate ligament release, resulting in significant symptom relief. This case underscores the importance of considering MALS in patients with chronic abdominal pain, even those with complex medical histories.

Synchronous pancreatic adenocarcinoma and duodenal mucosa‑associated lymphoid tissue lymphoma: A case report

RATIONALE

Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is a rare condition. Simultaneous presence of pancreatic ductal adenocarcinoma along with duodenal MALT lymphoma has not been documented in the scientific literature. We report an exceptionally rare case of synchronous duodenal MALT lymphoma and pancreatic ductal adenocarcinoma.

PATIENT CONCERNS

A 75-year-old man was referred to our hospital with dyspepsia and weight loss.

DIAGNOSES

Esophagogastroduodenoscopy was performed, revealing synchronous tumor comprising pancreatic ductal adenocarcinoma and MALT lymphoma of the duodenum.

INTERVENTIONS

Given that the pancreatic carcinoma would be the primary determinant of prognosis, we prioritized treatment of the pancreatic carcinoma. Consequently, we performed a Whipple operation first. Post-operative pathologic examination revealed metastasis of pancreatic cancer to peri-pancreatic lymph nodes, whereas the MALT lymphoma was localized to the duodenum; therefore, only adjuvant chemotherapy for pancreatic cancer was performed.

OUTCOMES

To date, the patient has had no recurrence of either the pancreatic cancer or the MALT lymphoma.

LESSONS

To the best of our knowledge, this is the first case to be reported. Awareness of this co-occurrence may help diagnosis and management of similar cases.

Primary Gastric and Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma With Symptomatic Anemia

Mucosal-associated lymphoid tissue (MALT) is a low-grade lymphoma derived from marginal zone B cells in extranodal tissue. Gastric MALT lymphoma is frequently seen; however, duodenal MALT lymphoma is rare, and there is no standardized knowledge up to date about the management of the disease. We present a case of a 56-year-old woman with gastric and duodenal MALT lymphoma.

Review of lymphoma in the duodenum: An update of diagnosis and management

The presentation, subtype, and macroscopic images of lymphoma vary depending on the site of the tumor within the gastrointestinal tract. We searched PubMed for publications between January 1, 2012 and October 10, 2022, and retrieved 130 articles relating to duodenal lymphoma. A further 22 articles were added based on the manual screening of relevant articles, yielding 152 articles for full-text review. The most predominant primary duodenal lymphoma was follicular lymphoma. In this review, we provide an update of the diagnosis and man-agement of representative lymphoma subtypes occurring in the duodenum: Follicular lymphoma, diffuse large B-cell lymphoma, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, mantle cell lymphoma, and T-cell lymphomas.

Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) typically arises from sites such as the stomach, where there is no organized lymphoid tissue. Close associations between Helicobacter pylori and gastric MALT lymphoma or Campylobacter jejuni and immunoproliferative small intestinal disease (IPSID) have been established. A subset of tumors is associated with chromosomal rearrangement and/or genetic alterations. This disease often presents as localized disease, requiring diverse treatment approaches, from antibiotic therapy to radiotherapy and immunochemotherapy. Eradication therapy for H. pylori effectively cures gastric MALT lymphoma in most patients. However, treatment strategies for H. pylori-negative gastric MALT lymphoma are still challenging. In addition, the effectiveness of antibiotic therapy has been controversial in intestinal MALT lymphoma, except for IPSID. Endoscopic treatment has been noted to usually achieve complete remission in endoscopically resectable colorectal MALT lymphoma with localized disease. MALT lymphoma has been excluded from post-transplant lymphoproliferative disorders with the exception of Epstein-Barr virus (EBV)-positive marginal zone lymphoma (MZL). We also describe the expanding spectrum of EBV-negative MZL and a close association of the disease with the gastrointestinal tract.

Synchronous duodenal mucosa-associated lymphoid tissue lymphoma and gastric cancer

Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare tumor. Herein, we report multidisciplinary treatment of a patient with synchronous development of primary MALT lymphoma of the duodenum and gastric cancer. A 70-year-old woman was referred to our hospital for examination of a gastric cancer initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy showed an elevated lesion with a central ulcer in the lower body of the stomach, and a partially whitish aggregated lesion in the descending portion of the duodenum. Histopathological examination of biopsy specimens from the gastric lesion showed moderately differentiated adenocarcinoma, and duodenal specimens showed low-grade MALT lymphoma composed of atypical lymphoid cells with a lymphoepithelial lesion. The patient underwent distal gastrectomy with regional lymph node dissection for the gastric cancer. Histological examination showed muscularis propria invading adenocarcinoma with two lymph node metastases. After operation, four courses of systemic rituximab treatment were administered for the MALT lymphoma, followed by adjuvant S-1 (tegafur/gimeracil/oteracil) chemotherapy for the gastric cancer. In the 4 months after operation, the patient was well with no evidence of recurrence. To the best of our knowledge, this is the second reported case of synchronous gastric adenocarcinoma and duodenal MALT lymphoma in the English literature.