Endoscopy 2012; 44(S 02): E167-E168
DOI: 10.1055/s-0031-1291758
Unusual cases and technical notes
© Georg Thieme Verlag KG Stuttgart · New York

First report of a mucosa-associated lymphoid tissue (MALT) lymphoma of the esophagus diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)

T. Ogura
1  Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
2  2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
M. Tajika
3  Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
,
S. Hijioka
1  Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
,
K. Hara
1  Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
,
S. Haba
1  Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
,
W. Hosoda
4  Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
,
Y. Yatabe
4  Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
,
S. Asano
5  Department of Respiratory Medicine, Handa Municipal Hospital, Nagoya, Japan
,
K. Higuchi
2  2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
,
K. Yamao
1  Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
,
Y. Niwa
3  Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
› Author Affiliations
Further Information

Corresponding author

M. Tajika
1-1 Kanokoden
Chikusa-ku
Nagoya 464-8681
Japan   
Fax: +81-527635233   

Publication History

Publication Date:
23 May 2012 (online)

 

Mucosa-associated lymphoid tissue (MALT) lymphoma of the esophagus is a rare tumor [1] [2] [3] with varying presentations [4]. Only a few reports have described MALT lymphoma of the esophagus spanning the entire circumference and length of the esophagus [3]. Many of these cases were diagnosed surgically. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an established method of obtaining submucosal tissue specimens [5]. We report here the first case of MALT lymphoma of the esophagus diagnosed by EUS-FNA.

A 60-year-old woman attended our institution due to dysphagia. Upper gastrointestinal endoscopy revealed a smooth surface with visible capillaries over the entire circumference of the esophagus and a white, soft, elastic submucosal tumor covered by normal mucosa ([Fig. 1]). An esophagogram showed a slightly elevated submucosal tumor extending over the entire esophageal length ([Fig. 2]), and enhanced computed tomography demonstrated thickening of the left bronchial and esophageal walls along with swelling of the pharyngeal lymph nodes. Endoscopic ultrasonography revealed a tumorous lesion presenting as a primarily hypoechoic mass arising in the third layer, with a hyperechoic region.

Zoom Image
Fig. 1 Endoscopic findings in a 60-year-old woman with dysphagia: a large, rounded mass with normal overlying mucosa is seen extending longitudinally along the entire esophagus.
Zoom Image
Fig. 2 Esophagogram showing a large submucosal tumor with luminal narrowing of the whole of the esophagus.

Because a diagnosis was not reached using specimens obtained with biopsy forceps, EUS-FNA was performed ([Fig. 3]). The presence of small- to medium-sized lymphocytic cells with mildly irregular nuclei, along with CD5(–), CD10(–), CD19(+), CD20(+), CD22 (+), and λ monoclonality on flow cytometry, led to a diagnosis of MALT lymphoma of the esophagus ([Fig. 4]). We described the tumor as a malignant, extramarginal zone B-cell lymphoma of the MALT type, clinical stage IV (Lugano International Conference classification). The patient was treated with a total of six courses of chemotherapy with rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone (R-CHOP), and a complete response was achieved.

Zoom Image
Fig. 3 Endoscopic ultrasound showing a hypoechoic thickening in the third layer. Endoscopic ultrasound-guided fine-needle aspiration was carried out using a 22-G needle (arrows).
Zoom Image
Fig. 4 Small- to medium-sized lymphocytic cells with mildly irregular nuclei.

To the best of our knowledge, this is the first report of EUS-FNA diagnosis of MALT lymphoma of the esophagus.

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB


#

Competing interests: None


Corresponding author

M. Tajika
1-1 Kanokoden
Chikusa-ku
Nagoya 464-8681
Japan   
Fax: +81-527635233   


Zoom Image
Fig. 1 Endoscopic findings in a 60-year-old woman with dysphagia: a large, rounded mass with normal overlying mucosa is seen extending longitudinally along the entire esophagus.
Zoom Image
Fig. 2 Esophagogram showing a large submucosal tumor with luminal narrowing of the whole of the esophagus.
Zoom Image
Fig. 3 Endoscopic ultrasound showing a hypoechoic thickening in the third layer. Endoscopic ultrasound-guided fine-needle aspiration was carried out using a 22-G needle (arrows).
Zoom Image
Fig. 4 Small- to medium-sized lymphocytic cells with mildly irregular nuclei.