title: MALT lymphoma of the small bowel with protein-losing enteropathy.
abstract: Mucosa-associated lymphoid tissue (MALT) lymphoma usually arises from chronic inflammation. We herein report a case of small intestinal MALT lymphoma with protein-losing enteropathy (PLE). A 73-year-old woman presented with lower leg edema and severe hypoalbuminemia. She had a medical history of pylorus-preserving pancreaticoduodenectomy with Billroth II reconstruction. Oral and anal route double-balloon enteroscopies revealed irregular nodular mucosal lesions with erosion extending from the jejunum to terminal ileum. Histopathological evaluation of the biopsied mucosa showed proliferation of small-to-medium-sized lambda light chain-restricted B cells. Plasmacytic differentiation and lymphoepithelial lesions were present, leading to the diagnosis of MALT lymphoma. Tc-99m albumin scintigraphy indicated tracer exudation in the small bowel, suggesting the presence of PLE. Combination immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen improved both MALT lymphoma and PLE, whereas rituximab monotherapy was not successful. This case is considered to be common type of MALT lymphoma at an uncommon site and is distinct from immunoproliferative small intestinal disease (IPSID). To our knowledge, this is the first case of non-IPSID-type small intestinal MALT lymphoma complicated by PLE. Gastrointestinal reconstruction may be responsible for underlying chronic inflammation via small intestinal bacterial overgrowth.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Ayato
authors.initials: A
authors.lastname: Tsukamoto
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nakamura
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Nannya
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Junji
authors.initials: J
authors.lastname: Shibahara
authors.forename: Motoshi
authors.initials: M
authors.lastname: Ichikawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D007082:Ileum / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D007580:Jejunal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D007583:Jejunum / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D011241:Prednisone / Q000627:therapeutic use; D011504:Protein-Losing Enteropathies / Q000209:etiology* / Q000517:prevention & control; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone