Endoscopy 2013; 45(S 02): E296-E297
DOI: 10.1055/s-0032-1309393
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Colorectal involvement of follicular lymphoma – findings with narrow band imaging and magnifying endoscopy

D. Norimura
1  Department of Gastroenterology and Hepatology, Sasebo Municipal General Hospital, Sasebo, Japan
,
H. Isomoto
2  Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
› Author Affiliations
Further Information

Corresponding author

D. Norimura, MD
Sasebo Municipal General Hospital
9-3 Hirase
Sasebo 857-8511
Japan   
Fax: +81-95-6224641   

Publication History

Publication Date:
05 September 2013 (online)

 

Follicular lymphoma occurs rarely in the gastrointestinal tract. Although prior studies have reported cases of follicular lymphoma in the gastrointestinal tract by using advanced endoscopic imaging studies [1] [2] [3], observation of colorectal involvement of follicular lymphoma using magnifying endoscopy with narrow band imaging (ME-NBI) has rarely been described.

A 69-year-old woman with follicular lymphoma underwent colonoscopy to investigate mild anemia and bloody stool. Colonoscopy showed multiple lymphomatous polyposis (MLP) through the whole colorectum ([Fig. 1]). ME-NBI highlighted coiled and elongated microvascular patterns on the surface of each lesion, and white opaque spots under the microvessels ([Fig. 2]). The microscopic examination of samples taken from the lesions showed the follicular structures consisting of medium-sized abnormal lymphoid cells with dense nuclei ([Fig. 3]). Immunohistochemical analysis revealed that the neoplastic cells were positive for CD20 and Bcl-2, but negative for CD3, and hence the patient was diagnosed as having colorectal involvement of follicular lymphoma.

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Fig. 1 Total colonoscopy revealed multiple lymphomatous polyposis.
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Fig. 2 Magnifying endoscopy of the area indicated by a yellow rectangle in [Fig. 1]: moderate zoom (a, b); full zoom (c, d). a Magnifying endoscopy showed abnormal microvessels on the surface of each lesion and lymphoid follicles (arrows). b Magnifying endoscopy with narrow band imaging highlighted coiled and elongated microvascular patterns on the surface of each lesion, and white opaque spots (arrows) under the microvessels. c Magnifying endoscopy of the area indicated by the yellow rectangle in [Fig. 2 a]. d Magnifying endoscopy with narrow band imaging highlighted coiled and elongated microvascular patterns on the surface of each lesion.
Zoom Image
Fig. 3 The microscopic examination of samples taken from the lesions showed the follicular structures consisting of medium-sized abnormal lymphoid cells with dense nuclei.

We report a rare case of the colorectal involvement of follicular lymphoma, manifesting as MLP. The endoscopic findings with ME-NBI of colorectal follicular lymphoma have not been clarified. In this case, ME-NBI clearly identified the characteristic coiled and elongated microvascular patterns at the surface of each lesion, and white opaque spots under the microvessels. We believe that ME-NBI is useful for the diagnosis of colorectal follicular lymphoma.

Endoscopy_UCTN_Code_CCL_1AD_2AC


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Competing interests: None


Corresponding author

D. Norimura, MD
Sasebo Municipal General Hospital
9-3 Hirase
Sasebo 857-8511
Japan   
Fax: +81-95-6224641   


Zoom Image
Fig. 1 Total colonoscopy revealed multiple lymphomatous polyposis.
Zoom Image
Fig. 2 Magnifying endoscopy of the area indicated by a yellow rectangle in [Fig. 1]: moderate zoom (a, b); full zoom (c, d). a Magnifying endoscopy showed abnormal microvessels on the surface of each lesion and lymphoid follicles (arrows). b Magnifying endoscopy with narrow band imaging highlighted coiled and elongated microvascular patterns on the surface of each lesion, and white opaque spots (arrows) under the microvessels. c Magnifying endoscopy of the area indicated by the yellow rectangle in [Fig. 2 a]. d Magnifying endoscopy with narrow band imaging highlighted coiled and elongated microvascular patterns on the surface of each lesion.
Zoom Image
Fig. 3 The microscopic examination of samples taken from the lesions showed the follicular structures consisting of medium-sized abnormal lymphoid cells with dense nuclei.