Rare gastrointestinal lymphomas: The endoscopic investigation

Abstract

Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin's lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease.

Detecting a rare composite small bowel lymphoma by Magnetic Resonance Imaging coincidentally: A case report with radiological, surgical and histopathological features

“…It usually appears as a white-tone polyposis with unifocal or multifocal distributions. Such large mass as our case is less common [10] , [11] , [12] , [13] , [14] . Although GI lymphoma histology can be varied.…”

“…This rare condition may explain the potential genetic relationship between two phenotypically different lymphomas, suggesting a common precursor. The literature reports about 21 cases of GI diffuse large B cell lymphoma with CHL [6] , but we didn’t find previous cases of small-bowel lymphoma with FL and CHL.Many tools are available to diagnose lymphoma [13] , [14] , [15] , [16] , [17] , [18] , including MRI that, in our case, helped us to diagnose this malignancy. This feature highlighted the crucial importance of radiological techniques in the investigation and work up of intestinal tumors [13] , [15] , [16] , [17] , [18] , [19] .…”

Gastrointestinal involvement by mantle cell lymphoma identified by biopsy performed during endoscopy

“…Using ordinary endoscopy, MCL appears in the forms of mucosa ulcers, polypoid type changes, masses, and others. [ 7 ] It is mainly characterized by homogeneously hypoechoic lesions that originate from the submucosa but do not affect the propria on EUS. [ 8 ] As the disease progresses, its original hierarchy will gradually disappear.…”

An unusual presentation of adult T-cell leukemia/lymphoma

“…Adult T-cell Leukemia/Lymphoma (ATL) is a specific variant of peripheral T-cell lymphoma that mainly presents in endemic areas of Japan and recognises the human T-lymphotropic virus-1 (HTLV-1) as an etiological agent [ 1 ].…”

“…Gastrointestinal involvement occurs secondary to systemic disease in about one third of ATL cases with the stomach being involved in 40%, small intestine in 38% and large intestine in 34% [ 1 , 4 ]. However, no endoscopic pattern could be related to a peculiar ATL subtype, and smoldering and chronic subtypes do not typically show GI involvement [ 1 , 5 ].…”