Follicular lymphoma of the duodenum: a clinicopathologic analysis of 26 cases.
OBJECTIVE
Follicular lymphomas (FLs) occur commonly in the lymph nodes, and duodenal FL (DFL) is reported to be rare.


METHODS
We analysed the clinical, morphological, immunohistochemical and genetic features of 26 cases of DFL. Primary DFLs and systemic FLs that involved the duodenum at any point during the clinical course were included in the analysis.


RESULTS
Typically, primary DFLs (14 cases) were found incidentally at routine medical check-ups, whereas involvement of the duodenum by systemic FLs (12 cases) was found through staging procedures. All cases involved the second portion of the duodenum. Helicobacter pylori infection was common (71%). In all cases, the histologic grade was low (either grade 1 or 2), and CD20, CD10 and Bcl-2 were positive by immunohistochemistry. Immunoglobulin heavy chain gene (IGH) and bcl-2 gene (BCL2) fusion was frequently shown by fluorescence in situ hybridization (FISH) analysis: nine of 12 cases (75%) of primary DFL and 10 of 12 cases (83%) of systemic DFL were positive. Treatment regimens employed were rituximab (R) plus chemotherapy (10), R (6), chemotherapy (3), irradiation (3) and the other three patients were subjected to observation. After a median follow-up duration of 40 months (ranging 11-96 months), 17 patients were alive without disease, seven were alive with disease and one had died of lymphoma.


CONCLUSIONS
Primary DFLs resemble systemic and nodal FLs, except that the former has high incidence of early stage and low-grade histology. The duodenum appears to be a frequently involved extranodal site of FL with IGH/BCL2.
Sentani
Kazuhiro
K
Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan.
Maeshima
Akiko Miyagi
AM
Nomoto
Junko
J
Maruyama
Dai
D
Kim
Sung-Won
SW
Watanabe
Takashi
T
Kobayashi
Yukio
Y
Tobinai
Kensei
K
Matsuno
Yoshihiro
Y
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D004379:Duodenal Neoplasms / Q000235:genetics / Q000473:pathology*; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008224:Lymphoma, Follicular / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics / Q000378:metabolism / Q000628:therapy; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000235:genetics; D015996:Survival Rate
D014408:Biomarkers, Tumor; D019253:Proto-Oncogene Proteins c-bcl-2