Successful treatment of an enormous rectal mucosa-associated lymphoid tissue lymphoma by endoscopic full-thickness resection: A case report

Abstract

BACKGROUND Colorectal mucosa-associated lymphoid tissue lymphoma (MALToma), a rare kind of nongastric MALToma, lacks consensus on its endoscopic features and standard therapies. According to previous studies on the clinical characteristics and outcomes of colorectal MALToma, endoscopic resection remains a good therapeutic strategy. CASE SUMMARY A 71-year-old woman suffered intermittent hematochezia for 1 mo, accompanied with abdominal pains but without weight loss, fever, chills or fatigue. Colonoscopy showed a massive hemispheric mass with rough and hyperemic mucosa in the lower rectum. Narrow-band imaging magnifying endoscopy detected some branching abnormal blood vessels and disappearance of glandular structure, which was similar with the tree-like appearance sign in gastric MALToma. Endoscopic ultrasonography revealed the lesion to be hypoechoic, boundary-defined, and echo uniform inside, originating from the muscularis propria. Abdominal enhanced computed tomography (CT) demonstrated a soft tissue mass with defined boundary. No enlarged superficial lymph nodes were detected by B-mode ultrasound. C 13 -urea breath test and serum Helicobacter pylori antibody were both negative. The patient underwent endoscopic full-thickness resection. Postoperative pathological analysis indicated colorectal MALToma. The patient remained asymptomatic after discharge, and follow-up positron emission tomography–CT and colonoscopy showed no residual lesion, remnants or lymph node metastasis. CONCLUSION This case provides new information on the specific endoscopic features of colorectal MALToma and an alternative treatment for patients.

A case of intestinal T‐cell lymphoma, not otherwise specified, that showed characteristic findings by magnified endoscopy combined with narrow‐band imaging

“…This has been described as a unique feature that is suggestive of gastric mucosal‐associated lymphoid tissue lymphoma 4 . The TLA has also been reported in rectal mucosal‐associated lymphoid tissue lymphoma 8 and intestinal follicular lymphoma, 9 but never in T‐cell lymphomas. Nonaka et al.…”

“…This has been described as a unique feature that is suggestive of gastric mucosal-associated lymphoid tissue lymphoma. 4 The TLA has also been reported in rectal mucosalassociated lymphoid tissue lymphoma 8 and intestinal follicular lymphoma, 9 but never in T-cell lymphomas. Nonaka et al described that the TLA reflects the loss of the glandular structure due to marked lymphoma cell infiltration and angiogenesis under the superficial layer of the mucosa.…”