title: Early, Isolated Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma Presenting without Symptoms or Grossly Apparent Endoscopic Lesions and Diagnosed by Random Duodenal Biopsies.
abstract: Clinical data regarding mucosa-associated lymphoid tissue lymphoma (MALToma) solely involving the duodenum are sparse because of the relative rarity of the disease. A comprehensive literature review revealed only 17 cases reported until 2004, and only a moderate number of cases have been reported since. MALToma can be asymptomatic in its very early stages but frequently produces localized or nonspecific symptoms, including early satiety, abdominal pain, vomiting, and involuntary weight loss in later stages. While gastric MALToma is strongly associated with gastric Helicobactor pylori infection, duodenal MALToma is often unassociated with H. pylori infection. A 74-year-old female presented with only dysphagia (without symptoms referable to a duodenal lesion), without systemic 'B' symptoms, and with no evident duodenal lesions at esophagogastroduodenoscopy; however, she was diagnosed with duodenal MALToma by pathologic examination of random duodenal biopsies performed to exclude celiac disease. An important clinical feature of this case is that duodenal MALToma was diagnosed by pathologic analysis of duodenal biopsies despite (1) no endoscopically apparent duodenal lesions; (2) duodenal involvement without gastric involvement; (3) lack of symptoms attributable to duodenal MALToma, and (4) absence of evident H. pylori infection. This work shows that early duodenal MALToma can be difficult to diagnose because of absent symptoms, absence of gastric involvement, absence of endoscopic abnormalities, and absence of H. pylori infection; it may require random duodenal biopsies for diagnosis.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich., USA.
authors.forename: Mihajlo
authors.initials: M
authors.lastname: Gjeorgjievski
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich., USA.
authors.forename: Issa
authors.initials: I
authors.lastname: Makki
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich., USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Khanal
authors.affiliation: Department of Pathology, William Beaumont Hospital, Royal Oak, Mich., USA.
authors.forename: Mitual B
authors.initials: MB
authors.lastname: Amin
authors.affiliation: Department of Pathology, Oakland University William Beaumont School of Medicine, Royal Oak, Mich., USA.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Blenc
authors.affiliation: Division of Gastroenterology and Hepatology, Oakland University William Beaumont Hospital, Royal Oak, Mich., USA.
authors.forename: Tusar
authors.initials: T
authors.lastname: Desai
authors.affiliation: Division of Gastroenterology, Oakland University William Beaumont School of Medicine, Royal Oak, Mich., USA.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cappell
keywords: Duodenum; Esophagogastroduodenoscopy; Helicobacter pylori; Lymphoma; Mucosa-associated lymphoid tissue lymphoma