Primary Small Intestinal Mucosa-associated Lymphoid Tissue Lymphoma Diagnosed by Balloon-assisted Enteroscopy

Abstract

A 78-year-old Japanese woman presented with anemia. Oral double-balloon endoscopy (DBE) detected multiple ulcerative lesions covered with coagula extending up to approximately 20 cm from the mid-jejunum. Based on the histopathological findings, the patient's condition was diagnosed as mucosa-associated lymphoid tissue (MALT) lymphoma of the small intestine. During the second DBE examination, a small intestinal perforation occurred in one of the ulcerative lesions, and an emergency segmental small intestinal resection was performed. The present case suggests that in MALT lymphoma, intestinal wall fragility may lead to perforation even though the lesion may appear to be a superficial ulcer on endoscopy.

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

“…Surgical treatment is now restricted to gastric MALT lymphoma cases with rare complications, such as bleeding or perforation, that cannot be controlled endoscopically [ 57 ]. Patients with small intestinal MALT lymphoma causing a dilated segment, obstruction, or perforation undergo surgical resection, some of whom receive additional chemo-/immunotherapy ( Table 3 ) [ 31 , 32 , 104 , 105 ]. Colonic MALT lymphoma cases of locally extended masses occasionally undergo surgical resection [ 43 , 71 ].…”

Small bowel mucosa‐associated lymphoid tissue lymphoma: A case report and literature review

“…Unlike gastric MALT lymphomas, the endoscopic characteristics of small intestinal MALT lymphomas are rarely described in the literature, and present as multiple ulcerative and erosive lesions with irregular nodularity and infiltrative sessile mass lesions. Despite advances in video capsule enteroscopy and balloon‐assisted enteroscopy, the diagnosis of small bowel MALT lymphoma remains a challenge . In our case, an infiltrating submucosal mass lesion, which nearly caused bowel lumen obstruction, was found in the jejunum using single‐balloon‐assisted enteroscopy.…”

“…However, with advances in video capsule endoscopy and balloon‐assisted enteroscopy, the possibility exists to visualize the whole bowel lumen of small intestine. Therefore, the incidence of small intestinal MALT lymphoma endoscopically detected may increase …”