DOI QR코드

DOI QR Code

위 상피하 종양으로 발견된 소포림프종 2예

Gastric Follicular Lymphomas Presenting as Subepithelial Tumors: Two Cases

  • 김형진 (부산대학교 의과대학 내과학교실, 양산부산대학교병원 의생명융합연구소) ;
  • 최철웅 (부산대학교 의과대학 내과학교실, 양산부산대학교병원 의생명융합연구소) ;
  • 박수범 (부산대학교 의과대학 내과학교실, 양산부산대학교병원 의생명융합연구소) ;
  • 김수진 (부산대학교 의과대학 내과학교실, 양산부산대학교병원 의생명융합연구소)
  • Kim, Hyeong Jin (Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital,) ;
  • Choi, Cheol Woong (Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital,) ;
  • Park, Su Bum (Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital,) ;
  • Kim, Su Jin (Department of Internal Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital,)
  • 투고 : 2018.07.18
  • 심사 : 2018.10.27
  • 발행 : 2018.12.31

초록

Follicular lymphoma is the most common form of low-grade B cell lymphoma. Follicular lymphoma occurs predominantly at lymph node sites and rarely in the gastrointestinal tract. Rare gastrointestinal follicular lymphoma is most commonly found in the small intestine, especially in the duodenum, and appears as multiple granules. However, gastric follicular lymphoma mostly appears as a subepithelial tumor. We observed two primary gastric follicular lymphomas that resembled subepithelial tumors located in the body of the stomach. Endoscopic ultrasound revealed hypoechoic lesions located in the submucosa layer. Since endoscopic forceps biopsies were inconclusive, we performed endoscopic submucosal dissection, which resulted in a final pathologic diagnosis of follicular lymphoma. Because of the indolent nature of gastrointestinal follicular lymphoma, the "watch and wait" strategy can be applied in the early phase. The identification of endoscopic characteristics of gastric follicular lymphoma can be helpful for differential diagnosis and decision of treatment strategy. Therefore, we report two cases of primary gastrointestinal follicular lymphoma diagnosed following endoscopic submucosal dissection.

키워드

과제정보

연구 과제 주관 기관 : Pusan National University Yangsan Hospital

참고문헌

  1. Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD, Linet MS. Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood 2006;107:265-276. https://doi.org/10.1182/blood-2005-06-2508
  2. Sant M, Allemani C, Tereanu C, et al. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood 2010;116:3724-3734.
  3. Freedman A. Follicular lymphoma: 2018 update on diagnosis and management. Am J Hematol 2018;93:296-305. https://doi.org/10.1002/ajh.24937
  4. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016;127:2375-2390. https://doi.org/10.1182/blood-2016-01-643569
  5. Yoshino T, Miyake K, Ichimura K, et al. Increased incidence of follicular lymphoma in the duodenum. Am J Surg Pathol 2000;24:688-693. https://doi.org/10.1097/00000478-200005000-00007
  6. Takata K, Okada H, Ohmiya N, et al. Primary gastrointestinal follicular lymphoma involving the duodenal second portion is a distinct entity: a multicenter, retrospective analysis in Japan. Cancer Sci 2011;102:1532-1536. https://doi.org/10.1111/j.1349-7006.2011.01980.x
  7. Maeshima AM, Taniguchi H, Suzuki T, et al. Comparison of clinicopathologic characteristics of gastric follicular lymphomas and duodenal follicular lymphomas. Hum Pathol 2017;65:201-208. https://doi.org/10.1016/j.humpath.2017.04.025
  8. Shia J, Teruya-Feldstein J, Pan D, et al. Primary follicular lymphoma of the gastrointestinal tract: a clinical and pathologic study of 26 cases. Am J Surg Pathol 2002;26:216-224. https://doi.org/10.1097/00000478-200202000-00008
  9. Yamamoto S, Nakase H, Yamashita K, et al. Gastrointestinal follicular lymphoma: review of the literature. J Gastroenterol 2010;45:370-388. https://doi.org/10.1007/s00535-009-0182-z
  10. Chouhan J, Batra S, Gupta R, Guha S. Gastrointestinal follicular lymphoma: using primary site as a predictor of survival. Cancer Med 2016;5:2669-2677. https://doi.org/10.1002/cam4.763
  11. Freedman AS. Biology and management of histologic transformation of indolent lymphoma. Hematology Am Soc Hematol Educ Program 2005;1:314-320.
  12. Casulo C, Byrtek M, Dawson KL, et al. Early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death: an analysis from the National LymphoCare Study. J Clin Oncol 2015;33:2516-2522. https://doi.org/10.1200/JCO.2014.59.7534
  13. Takata K, Miyata-Takata T, Sato Y, Yoshino T. Pathology of follicular lymphoma. J Clin Exp Hematop 2014;54:3-9. https://doi.org/10.3960/jslrt.54.3
  14. Chau I, Jones R, Cunningham D, et al. Outcome of follicular lymphoma grade 3: is anthracycline necessary as front-line therapy? Br J Cancer 2003;89:36-42. https://doi.org/10.1038/sj.bjc.6601006
  15. Relander T, Johnson NA, Farinha P, Connors JM, Sehn LH, Gascoyne RD. Prognostic factors in follicular lymphoma. J Clin Oncol 2010;28:2902-2913. https://doi.org/10.1200/JCO.2009.26.1693
  16. Na HY, Kim YA, Lee C, et al. Gastric follicular lymphoma: a report of 3 cases and a review of the literature. Oncol Lett 2018;16:741-748.
  17. Schmatz AI, Streubel B, Kretschmer-Chott E, et al. Primary follicular lymphoma of the duodenum is a distinct mucosal/submucosal variant of follicular lymphoma: a retrospective study of 63 cases. J Clin Oncol 2011;29:1445-1451. https://doi.org/10.1200/JCO.2010.32.9193
  18. Hunt GC, Smith PP, Faigel DO. Yield of tissue sampling for submucosal lesions evaluated by EUS. Gastrointest Endosc 2003;57:68-72.
  19. Ji JS, Lee BI, Choi KY, et al. Diagnostic yield of tissue sampling using a bite-on-bite technique for incidental subepithelial lesions. Korean J Intern Med 2009;24:101-105. https://doi.org/10.3904/kjim.2009.24.2.101
  20. Kim GH, Cho YK, Kim EY, et al. Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling. Scand J Gastroenterol 2014;49:347-354. https://doi.org/10.3109/00365521.2013.867361