Case Report
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World J Gastroenterol. Dec 28, 2014; 20(48): 18487-18494
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18487
Colonic mucosa-associated lymphoid tissue lymphoma identified by chromoendoscopy
Sang-Wook Seo, Seung-Hwa Lee, Duck-Joo Lee, Kwang-Min Kim, Joon-Koo Kang, Do-Wan Kim, Jeong-Hun Lee
Sang-Wook Seo, Seung-Hwa Lee, Duck-Joo Lee, Kwang-Min Kim, Center for Health Promotion, Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon 443-380, South Korea
Joon-Koo Kang, Department of Gastroenterology, Ajou University School of Medicine, Suwon 443-380, South Korea
Do-Wan Kim, Department of Anesthesiology, Ajou University School of Medicine, Suwon 443-380, South Korea
Jeong-Hun Lee, Department of Surgery, Ajou University School of Medicine, Suwon 443-380, South Korea
Author contributions: Seo SW drafted the report; Lee SH designed the manuscript; Lee SH, Lee DJ, Kim KM, Kang JK, Kim DW, and Lee JH reviewed and revised the paper.
Correspondence to: Seung-Hwa Lee, MD, Professor, Center for Health Promotion, Department of Family Practice and Community Health, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Gyeonggi-do, Suwon 443-380, South Korea. drhwa@hanmail.net
Telephone: +82-31-2197164 Fax: +82-31-2195561
Received: July 5, 2014
Revised: August 18, 2014
Accepted: October 15, 2014
Published online: December 28, 2014
Processing time: 184 Days and 22.7 Hours
Abstract

Colonic mucosa-associated lymphoid tissue (MALT) lymphomas are a rare occurrence and the definitive treatment has not been established. Solitary or multiple, elevated or polypoid lesions are the usual appearances of MALT lymphoma in the large intestine and sometimes the surface may reveal abnormal vascularity. Herein, we report a case of MALT lymphoma and review the relevant literature. Upon colonoscopy, a suspected pathologic lesion was observed in the proximal transverse colon. The lesion could be distinguished more prominently after using narrow-band imaging mode and indigo carmine-dye spraying chromoendoscopy. Histopathologic examination of this biopsy specimen revealed lymphoepithelial lesions with diffuse proliferation of atypical lymphoid cells effacing the glandular architecture and centrocyte-like cells infiltrating the lamina propria. Immunohistochemical analyses showed that tumor cells were positive for CD20 and Bcl-2e, and negative for CD10, CD23, and Bcl-6. According to Ann-Arbor staging system, the patient had stage IIE. A partial colectomy with dissection of the paracolic lymph nodes was performed. Until now, there is no recurrence of lymphoma at follow-up.

Keywords: Chromoendoscopy; Lymphoma; Mucosa-associated lymphoid tissue; Narrow-band imaging mode

Core tip: Mucosa-associated lymphoid tissue (MALT) lymphoma in the large intestine is a rare disease, but it is a clinically important condition that requires proper evaluation. Most of the colonic MALT lymphomas mainly present as a protruding and/or ulcerative lesion, and rarely present as a flat lesion. It is not easy to detect MALT lymphoma of the flat type and could be misdiagnosed. Thus, greater attention is needed for the detection and differential diagnosis of these lesions. The narrow-band imaging mode plus indigo carmine-dye spraying chromoendoscopy or/and endoscopic biopsy may be helpful for making the diagnosis.