title: Ileal mucosa-associated lymphoid tissue lymphoma presenting with small bowel obstruction: a case report.
abstract: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT Lymphoma) of the gastrointestinal tract commonly involves the stomach in the setting of concurrent Helicobacter pylori (H. pylori) infection. Primary ileal MALT lymphoma is rare, and has not been associated with a specific infectious disease. We report a case of a 58-year-old man who presented to the emergency department with constipation and abdominal distension, and signs of an obstructing mass on computed tomography scan. A small bowel resection was performed which revealed an 8 cm saccular dilatation with thickened bowel wall and subjacent thickened tan-yellow tissue extending into the mesentery. Histologically, there was a diffuse lymphoid infiltrate consisting of small atypical cells with monocytoid features. These cells were CD20-positive B-lymphocytes that co-expressed BCL-2 and were negative for CD5, CD10, CD43, and cyclin D1 on immunohistochemical studies. Kappa-restricted plasma cells were also identified by in situ hybridization. The overall proliferation index was low with Ki-67 immunoreactivity in approximately 10 % of cells. No areas suspicious for large cell or high grade transformation were identified. The pathologic findings were diagnostic of an extranodal marginal zone lymphoma involving the ileum, with early involvement of mesenteric lymph nodes. Small hypermetabolic right mesenteric and bilateral hilar lymph nodes were identified by imaging. The bone marrow biopsy showed no evidence of involvement by lymphoma. The patient was clinically considered advanced stage and opted for therapy with rituximab infusions. After six months of therapy, follow-up radiologic studies demonstrated significant decrease in size of the mesenteric lymph nodes.
authors.affiliation: Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA. zkinkade@hsc.wvu.edu.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Kinkade
authors.affiliation: Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA. oesan@hsc.wvu.edu.
authors.forename: Olukemi A
authors.initials: OA
authors.lastname: Esan
authors.affiliation: Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA. fgrosado@hsc.wvu.edu.
authors.forename: Flavia G
authors.initials: FG
authors.lastname: Rosado
authors.affiliation: Department of Medicine, Section of Hematology/Oncology, West Virginia University, PO Box 9162, Morgantown, WV, 26506, USA. mdcraig@hsc.wvu.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Craig
authors.affiliation: Department of Pathology, West Virginia University, PO Box 9203, Morgantown, WV, 26506, USA. jvos@hsc.wvu.edu.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Vos
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D006801:Humans; D007078:Ileal Neoplasms / Q000737:chemistry / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007150:Immunohistochemistry; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology; D018442:Lymphoma, B-Cell, Marginal Zone / Q000737:chemistry / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000069283:Rituximab / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D000069283:Rituximab