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A CASE OF DUODENAL FOLLICULAR LYMPHOMA TREATED WITH ENDOSCOPIC MUCOSAL RESECTION
Syed Mujtaba Baqir
*1, Carla Barberan Parraga
1, GianPaolo Piccione
2, Samar Pal Sandhu
1, Sarah Meribout
1, Ahmed Salem
1, Tanuj Chokshi
1, Manol Jovani
11Internal Medicine, Maimonides Medical Center, Brooklyn, NY; 2Richmond University Medical Center, Brooklyn, NY
Duodenal-type follicular lymphoma (D-FL) is a recently recognized entity considered a form of follicular lymphoma (FL). We describe a case of duodenal follicular lymphoma treated with endoscopic mucosal resection (EMR). A 51-year-old woman, with no significant past medical history, underwent esophagogastroduodenoscopy (EGD). In the third portion of the duodenum there was a Paris 0-IIA, NICE type 2, flat lesion measuring about 20mm. The lesion was resected piecemeal with the EMR technique. Complete resection was achieved. Soft tip coagulation of the margins was performed to reduce the risk of polyp recurrence. The mucosal defect was closed with 3 clips. Pathology was positive for numerous, monomorphic lymphoid follicles within the mucosa. The neoplastic cells co-expressed CD20, CD10, BCL-2, and BCL6. The overall features were those of a low-grade follicular lymphoma. The case was discussed at a multidisciplinary setting and only follow up was recommended. The patient was followed with cross-sectional imaging which was negative both at 2 weeks after EMR and at 6 months follow up. The patient underwent EGD with endoscopic ultrasound (EUS) about 10 months after EMR, confirming no disease recurrence. This case highlights the possibility of a complete treatment of low-grade duodenal follicular lymphoma with standard endoscopic techniques.
Paris 0-IIa, NICE type 2 lesion measuring about 20 mm in the third portion of the duodenum (A) undergoing piecemeal mucosal resection (B). No residual polyp was seen and the mucosal defect was closed with 3 clips (C).
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