- Email: [email protected]
A solitary polypoid mucosa-associated lymphoid tissue lymphoma in the colon
AT THE FOCAL POINT Mohamed O. Othman, MD, Associate Editor for Focal Points
A solitary polypoid mucosa-associated lymphoid tissue lymphoma in the colon
A 60-year-old woman presented with chronic recurrent ulcerative colitis for 8 years. A monitoring colonoscopy was performed to evaluate her condition, demonstrating a 5-mm polypoid lesion in the sigmoid colon (A). EUS showed a hypoechoic, homogeneous lesion with welldefined margins, which originated from the muscularis mucosa (B, arrows). Subsequent upper endoscopy; enhanced CT of the neck, thorax, and abdomen; and bone marrow aspiration found no significant abnormalities. Under the patient’s and her family’s consent, endoscopic resection was performed to remove the lesion. Postoperative pathologic examination demonstrated a www.giejournal.org
mucosa-associated lymphoid tissue (MALT) lymphoma (C, H&E; Supplementary Fig. 1, available online at www. giejournal.org). After the procedure, she continued to use oral mesalamine and prednisone to treat her ulcerative colitis. During 7 years of follow-up, no evidence of lymphoma recurrence was noted, but her ulcerative colitis persisted (D). Although several reports have revealed increased risks of lymphoma in patients with inflammatory bowel diseases, no certain association was noted when those reports were aggregated with large population-based studies. The fact that there was no tumor recurrence in this patient Volume
-,
No.
-
: 2019 GASTROINTESTINAL ENDOSCOPY 1
At the Focal Point
may suggest no significant correlation between ulcerative colitis and MALT lymphoma. Local resection may be considered to treat such a solitary polypoid MALT lymphoma.
DISCLOSURE
ACKNOWLEDGMENT
Liansong Ye, MD, Yufang Wang, MD, Jiang Du, NP, Bing Hu, MD, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
We acknowledge the support from Sichuan Province Science and Technology Department (China) (2017SZ0009).
All authors disclosed no financial relationships relevant to this publication.
https://doi.org/10.1016/j.gie.2019.09.001
Commentary Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (commonly referred to as MALT or MALToma) refers to a group of lymphomas of B cell origin. Most commonly seen in the stomach in association with Helicobacter pylori infection, MALTomas can arise at various places throughout the GI tract. MALTomas can also be seen in association with autoimmune disorders (eg, lupus, Sjögren syndrome), Chlamydia psittaci infection, Campylobacter jejuni infection, and other bacterial infections. Multiple chromosomal abnormalities are also associated with MALToma. In this patient, colonic MALToma arose in the setting of ulcerative colitis. Although rare, this is not novel and has been reported in multiple prior cases. It is likely that the development of MALToma in this patient is coincidental, but a pathologic association between the 2 illnesses cannot be ruled out. Douglas G. Adler GIE Senior Associate Editor University of Utah School of Medicine Salt Lake City, Utah Mohamed O. Othman, MD Associate Editor for Focal Points
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2019
www.giejournal.org
At the Focal Point
Supplementary Fig. 1. ---.
www.giejournal.org
Volume
-,
No.
-
: 2019 GASTROINTESTINAL ENDOSCOPY 2.e1
A solitary polypoid mucosa-associated lymphoid tissue lymphoma in the colon
A 60-year-old woman presented with chronic recurrent ulcerative colitis for 8 years. A monitoring colonoscopy was performed to evaluate her condition, demonstrating a 5-mm polypoid lesion in the sigmoid colon (A). EUS showed a hypoechoic, homogeneous lesion with welldefined margins, which originated from the muscularis mucosa (B, arrows). Subsequent upper endoscopy; enhanced CT of the neck, thorax, and abdomen; and bone marrow aspiration found no significant abnormalities. Under the patient’s and her family’s consent, endoscopic resection was performed to remove the lesion. Postoperative pathologic examination demonstrated a www.giejournal.org
mucosa-associated lymphoid tissue (MALT) lymphoma (C, H&E; Supplementary Fig. 1, available online at www. giejournal.org). After the procedure, she continued to use oral mesalamine and prednisone to treat her ulcerative colitis. During 7 years of follow-up, no evidence of lymphoma recurrence was noted, but her ulcerative colitis persisted (D). Although several reports have revealed increased risks of lymphoma in patients with inflammatory bowel diseases, no certain association was noted when those reports were aggregated with large population-based studies. The fact that there was no tumor recurrence in this patient Volume
-,
No.
-
: 2019 GASTROINTESTINAL ENDOSCOPY 1
At the Focal Point
may suggest no significant correlation between ulcerative colitis and MALT lymphoma. Local resection may be considered to treat such a solitary polypoid MALT lymphoma.
DISCLOSURE
ACKNOWLEDGMENT
Liansong Ye, MD, Yufang Wang, MD, Jiang Du, NP, Bing Hu, MD, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
We acknowledge the support from Sichuan Province Science and Technology Department (China) (2017SZ0009).
All authors disclosed no financial relationships relevant to this publication.
https://doi.org/10.1016/j.gie.2019.09.001
Commentary Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (commonly referred to as MALT or MALToma) refers to a group of lymphomas of B cell origin. Most commonly seen in the stomach in association with Helicobacter pylori infection, MALTomas can arise at various places throughout the GI tract. MALTomas can also be seen in association with autoimmune disorders (eg, lupus, Sjögren syndrome), Chlamydia psittaci infection, Campylobacter jejuni infection, and other bacterial infections. Multiple chromosomal abnormalities are also associated with MALToma. In this patient, colonic MALToma arose in the setting of ulcerative colitis. Although rare, this is not novel and has been reported in multiple prior cases. It is likely that the development of MALToma in this patient is coincidental, but a pathologic association between the 2 illnesses cannot be ruled out. Douglas G. Adler GIE Senior Associate Editor University of Utah School of Medicine Salt Lake City, Utah Mohamed O. Othman, MD Associate Editor for Focal Points
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2019
www.giejournal.org
At the Focal Point
Supplementary Fig. 1. ---.
www.giejournal.org
Volume
-,
No.
-
: 2019 GASTROINTESTINAL ENDOSCOPY 2.e1