Intestinal lymphoma and sprue: A systematic approach

Abstract

SUMMARY Intestinal lymphoma is frequently associated with sprue-like bowel patterns. A standardized approach to the problem is suggested.Intestinal lymphoma has been subdivided into four groups, depending on the extent of involvement of the anatomical region. Only cases with specific lesions are accepted as primary lymphoma.The villous pattern in 179 cases at necropsy with suitably preserved mucosa was determined to form a normal baseline for comparison with the uninvolved portions of the lymphomatous small bowel. Only 15 % of all small bowel of this random material of children more than 1 year old and adults showed a flattened mucosa.The non-lymphomatous mucosa of 20 cases with definitely primary intestinal reticulum or lymphosarcoma showed severe sprue-like atrophy in 18 (90%). Two cases of intestinal Hodgkin's disease and four cases of gastric lymphoma were associated with regular mucosal patterns.It is concluded that sprue-like villous atrophy of the small bowel is definitely a triggering factor for the development of primary intestinal reticulum cell or lymphosarcoma. A hypothesis for the possible aetiological relationship of these two conditions is discussed.

A Case of Primary T-Cell Lymphoma of the Duodenum

“…The cause of lymphoma of the duodenum remains unclear. Lymphomas have been noted to occur with increasing frequency in patients with an adult celiac disease, nontropical sprue, steatorrhea of many years’ duration Hashimoto’s thyroiditis, Sjogren’s syndrome, and other conditions 24 – 26 ) but the rarity of the disease has precluded the precise identification of such factors.…”

Lymphoma arising in mucosa-associated lymphoid tissue of the duodenal bulb

“…Lymphomas have been noted to occur with increased frequency in patients with adult celiac disease, nontropical sprue, chronic steatorrhea, Sjögren's syndrome, and other conditions. [18][19][20][21][22][23] There have been also several cases reported of malignant lymphoma developing in patients with Hashimoto's thyroiditis, 23 as in our patient. This entity may be involved in the development of MALToma of the duodenum, but the rarity of the disease has not allowed the precise identification of such factors.…”

Primary Gastrointestinal Involvement in Non-Hodgkin’s Lymphomas

“…Celiac disease [4,17,30,43], dermatitis herpetiformis [24], Crohn's disease [ 13], and ulcerative colitis [ 1 ] can be considered as predisposing factors in the develop ment of intestinal lymphomas. In a study by Dragosics et al [16], however, it was observed that 2 patients only showed villous atrophy before the appearance of lymphoma, 1 patient had a history of dermatitis herpe tiformis, whereas no Crohn's disease or ulcerative colitis was associated with or preceded the GI lym phoma.…”