Primary Localized Esophageal Mucosa-associated Lymphoid Tissue Lymphoma Treated by Endoscopic Submucosal Dissection

Kobayashi, Sayo; Iwamuro, Masaya; Nishida, Kenji; Tanaka, Takehiro; Kawahara, Yoshiro; Yoshino, Tadashi; Okada, Hiroyuki

doi:10.2169/internalmedicine.0487-17

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…The procedure also results in an improved differential diagnosis of malignant lymphoma occurring in digestive organs. To our knowledge, there have only been a few reports on ESD of early MALT lymphoma in the English literature (23)(24)(25)(26). In the case reported here, ESD of the esophagus en bloc removed the large lesions and additional radiation was administered.…”

Section: Discussionmentioning

confidence: 78%

En Bloc Resection of Primary Large Esophageal Mucosa-Associated Lymphoid Tissue Lymphoma by Endoscopic Submucosal Dissection: A Case Report

et al. 2021

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Treatment of mucosa-associated lymphoid tissue (MALT) lymphoma has recently received considerable attention. Here, we report a case of large esophageal MALT lymphoma that was successfully en bloc resected using endoscopic submucosal dissection (ESD). A 77-year-old woman was admitted to our hospital with progressive dysphagia for more than 2 months. Upper gastrointestinal endoscopy revealed a large rounded submucosal mass covered by normal mucosa, located at the lower esophagus. Endoscopic ultrasonography (EUS) showed a well-demarcated hypoechoic mass chiefly located in the esophageal wall, but the layers of the esophageal wall were not clear. ESD was performed for diagnostic and treatment purposes. No complications occurred during or after ESD. The resected specimen measured 4.3 cm × 2.8 cm × 1.5 cm. The histologic findings were diagnostic of esophageal MALT lymphoma. Infiltration of neoplastic cells in the lateral margins of the resected specimen was not observed. However, vertical margins showed an R1 situation and mild damage to the muscularis propria. After 3 months, her dysphagia disappeared. Additional radiation therapy was then administered. After 5 months, the patient was still under surveillance and free of recurrent disease. Resection with ESD of such a large mass of MALT in the esophageal region has rarely been reported before in the literature.

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Section: Discussionmentioning

confidence: 78%

En Bloc Resection of Primary Large Esophageal Mucosa-Associated Lymphoid Tissue Lymphoma by Endoscopic Submucosal Dissection: A Case Report

et al. 2021

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“…in the esophagus and presented with distinctive macroscopic features of bulky, diffuse esophageal wall thickening. To our knowledge, this report is the second to illustrate such esophageal MALT lymphoma (2), while most of the previously reported lesions were endoscopically observed as a subepithelial tumor (3).…”

Section: Picturementioning

confidence: 72%

Diffuse Esophageal Wall Thickening Due to Lymphoma

et al. 2021

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A 71-year-old Japanese man was referred to our hospital with difficulty swallowing, monoclonal gammopathy, an increased white blood cell count (9,650/mm 3 ), atypical lymphocytes (40%), anemia (hemoglobin, 9.5 g/dL), thrombocy-topenia (platelet count, 12,800/mm 3 ), and an increased soluble interleukin-2 receptor level (1,378 U/mL). Computed tomography showed bulky, diffuse esophageal wall thickening (Picture 1, arrows), in addition to orbital tumors and intrapleural and intra-abdominal lymphadenopathies. The tracer uptake in the tumors was observed on positron emission tomography (Picture 2, arrows). Esophagogastroduodenoscopy revealed extensive mucosal thickening, resulting in the narrowing of the esophageal lumen (Picture 3). A conventional endoscopic biopsy of the esophageal lesion using biopsy forceps led to the diagnosis of stage IV extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma showing small-to mediumsized atypical lymphoid cells, which were positive for CD 20, BCL2, and immune receptor translocation-associated protein 1 (IRTA1) and negative for CD3 and CD10 (1). The patient was treated with rituximab plus chemotherapy, which resulted in partial remission. In the present patient, it was noteworthy that the size of the lymphoma lesion was largest

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“…[ 2 , 8 , 21 , 22 ] Moreover, several lymphomas presented as SELs and treated with endoscopic resection have been reported. [ 23 – 27 ] In addition, according to the literature review, some other rare cases were treated with endoscopy, similar to follicular dendritic cell sarcoma and adenoid cystic carcinoma. [ 28 , 29 ]…”

Section: Discussionmentioning

confidence: 99%

Esophageal intramural squamous cell carcinomas presenting as subepithelial lesions removed by endoscopic submucosal dissection

Zhu

Shi

et al. 2020

Medicine

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Introduction: Esophageal subepithelial lesions (SELs) are rare, and the majority of them are benign. SELs are often covered with normal mucosa, thereby resulting in some malignant SELs to be easily missed or misdiagnosed. We report 2 cases of esophageal intramural squamous cell carcinomas (SCCs) that presented as SELs and were endoscopically removed. Patient concerns: Case 1 is a 63-year-old man with abdominal distension; case 2 is a 65-year-old man with increasing dysphagia for 2 months. Diagnosis: In case 1, endoscopy showed a 1.5-cm mucosal eminence with normal overlying mucosa. Endoscopic ultrasound (EUS) revealed that it might be derived from the muscularis mucosa or submucosa. In case 2, endoscopy revealed a 1.2-cm hemispherical lesion covered with smooth mucosa. Furthermore, EUS revealed that this lesion might be derived from the submucosa. Interventions: In both cases, the lesions were removed by endoscopic submucosal dissection (ESD). Pathological examination revealed esophageal SCC nests with intramural growth patterns. Outcomes: The first patient underwent postoperative radiotherapy, whereas the second patient did not receive any additional treatment. Both patients agreed to regular follow-up, and no tumor recurrence or metastasis was observed. Conclusion: First, not all esophageal SELs are benign, and a small number of SELs can be malignant. Second, these cases illustrate the value of newer endoscopic techniques, especially ESD. Thus, it is important to be alert when visualizing the esophagus for the possibility of a subtle SEL so that further evaluation and treatment, if necessary, can be undertaken, ideally with a less invasive approach afforded by ESD.

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Primary Localized Esophageal Mucosa-associated Lymphoid Tissue Lymphoma Treated by Endoscopic Submucosal Dissection

Cited by 10 publications

References 28 publications

En Bloc Resection of Primary Large Esophageal Mucosa-Associated Lymphoid Tissue Lymphoma by Endoscopic Submucosal Dissection: A Case Report

En Bloc Resection of Primary Large Esophageal Mucosa-Associated Lymphoid Tissue Lymphoma by Endoscopic Submucosal Dissection: A Case Report

Diffuse Esophageal Wall Thickening Due to Lymphoma

Esophageal intramural squamous cell carcinomas presenting as subepithelial lesions removed by endoscopic submucosal dissection

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