title: [Primary gastrointestinal follicular lymphoma of the small intestine with massive hemorrhage: a report of three cases].
abstract: Primary gastrointestinal follicular lymphoma (FL) has an indolent clinical presentation and many of cases are diagnosed incidentally during routine endoscopic examinations. Herein, we present 3 cases with FL of the small intestine developed massive intestinal hemorrhage that necessitated blood transfusion. In all three patients, upper and lower endoscopic examinations failed to detect the bleeding sites. Eventually, video capsule endoscopies identified ulcerative lesions in the jejunum and biopsies using single- or double-balloon endoscopy confirmed the FL diagnosis in our three cases. The respective clinical stages according to the Lugano system were I, II-1 and II-1. PET-CT did not play a significant role in identifying the gastrointestinal lesions. Two patients received rituximab monotherapy and achieved a complete response. The other remains under observation after termination of antiplatelet drug therapy. Generally, the macroscopic appearance of multiple whitish nodules and the absence of symptoms represent the typical clinical picture of gastrointestinal FL. However, this study demonstrates that patients with ulcerative lesions may be at risk for massive bleeding. Further discussion is required to determine the optimal indications for total endoscopic examination of the small intestine.
authors.affiliation: Division of Hematology-Oncology, Chiba Cancer Center.
authors.forename: Akiyasu
authors.initials: A
authors.lastname: Sato
authors.forename: Hideki
authors.initials: H
authors.lastname: Tsujimura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yamada
authors.forename: Keiko
authors.initials: K
authors.lastname: Ono
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wang
authors.forename: Takeaki
authors.initials: T
authors.lastname: Sugawara
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ise
authors.forename: Makiko
authors.initials: M
authors.lastname: Itami
authors.forename: Kyouya
authors.initials: K
authors.lastname: Kumagai
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004379:Duodenal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007580:Jejunal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D008224:Lymphoma, Follicular / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D000069283:Rituximab / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab