Non-Hodgkin malignant lymphoma of gastrointestinal tract detected by ultrasonography

Introduction: The gastrointestinal tract is the most frequent location for primary extra-nodal non-Hodgkin lymphomas. Primary NHLs located in the gastrointestinal tract account for only 1–4% of gastrointestinal malignancies. The complaints are very varied and often atypical depending on the different locations, which makes the diagnosis difficult.

Patients and Methods: A 40y old man was admitted urgently to our gastroenterology department with strong abdominal pain in the epigastric region. The laboratory examination showed normal westegreen and blood results and normal immunological and tumor marker parameters. Serum indirect bilirubin, ALAT and H.p. elevation were detected. The ultrasonography examination showed a solid mass in the postbulbar and paraaortic region of about 32×23mm expansion. The chest X-ray and abdominal CT were negative. The upper gastrointestinal endoscopy examination showed a slightly narrowed postbulbar duodenum in the papillar region with small polypoid lesions, from which biopsy was taken. The duodenal biopsy raised the possibility of a malignant B cell lymphoma therefore the biopsy from the postbulbar duodenum was repeated. The specimens gave positive stainings for CD20, CD3 and bc12. Keratin was positive in the upper duodenal mucosa. The results proved grade-I. follicular B cell lymphoma.

The patient underwent an operation with duodenal resection and after that he received chemotherapy.

Conclusion: Gastrointestinal lymphomas are an uncommon disease. There are certain risk factors for gastrointestinal lymphomas which have become known such as H.p., inflammatory bowel disease, immunosuppressive and cancer treatment. Taking into consideration that the incidence of these risk factors is on the rise, a more frequent occurrence of gastrointestinal lymphomas may also be anticipated. Non-invasive diagnostic tools such as ultrasonography may help in the detection of gastrointestinal lymphomas.