Synchronous indolent primary gastrointestinal lymphomas managed successfully with conservative measures.
We report the case of a 65-year-old man who presented with epigastric pain and guaic-positive stool. Upper and lower endoscopy revealed abnormalities in the gastric antrum and terminal ileum. Biopsy of these sites revealed histologically and immunophenotypically distinct lymphomas: gastric extranodal marginal zone lymphoma in the background of Helicobacter pylori infection and follicular lymphoma of the terminal ileum. After treatment with an H. pylori eradication regimen, repeat endoscopy showed resolution of the gastric extranodal marginal zone lymphoma and persistence of the ileal follicular lymphoma. Interestingly, molecular studies performed on the biopsy specimens revealed a common IgH rearrangement, suggesting a common precursor cell responsible for these two malignant processes. We present this unique case with a review of the literature, highlighting treatment principles for these two subtypes of indolent gastrointestinal non-Hodgkin lymphoma.
1Medical Oncology Branch and 2Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; and 3SAIC-Frederick, Frederick, MD.
Andrew S
AS
Brohl
Joo Y
JY
Song
Ron
R
Lieberman
Barry
B
Gause
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000453:epidemiology*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology*
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors