Akiyama Shintaro, Izutsu Koji, Ota Yasunori, Imamura Tsunao, Ogawa Osamu, Wake Atsushi, Takeuchi Kazuo
From the Department of Hematology (KI, AW); Department of Gastroenterology (SA, TI, OO, KT); Department of Pathology, Tokyo(YO); and Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan (AW).
Medicine (Baltimore). 2014 Nov;93(26):e165. doi: 10.1097/MD.0000000000000165.
A 46-year-old woman underwent upper endoscopy for evaluation of anemia, which revealed whitish granules at the duodenal papilla, diagnosed as duodenal follicular lymphoma (DFL) by biopsy. Computed tomography and abdominal ultrasonography revealed that follicular lymphoma was confined to the duodenum. Seven years after the diagnosis, fluorine-18 fluorodeoxyglucose positron emission tomography scanning revealed multiple lesions including in bone marrow and lymph nodes. Bone marrow biopsy of the right iliac bone revealed diffuse large B-cell lymphoma, indicating systemic dissemination and histologic transformation of the DFL. The patient responded to chemotherapy and has been progression-free for 2.5 years. Although DFL is usually indolent even without any treatment, systemic dissemination with histologic transformation can occur. This case suggests that the life-time follow-up that is usually done for patients with nodal follicular lymphoma should be provided to patients with DFL.
一名46岁女性因贫血接受了上消化道内镜检查，结果显示十二指肠乳头处有白色颗粒，经活检诊断为十二指肠滤泡性淋巴瘤（DFL）。计算机断层扫描和腹部超声检查显示滤泡性淋巴瘤局限于十二指肠。诊断7年后，氟-18氟脱氧葡萄糖正电子发射断层扫描显示包括骨髓和淋巴结在内的多个病灶。右髂骨骨髓活检显示弥漫性大B细胞淋巴瘤，提示DFL发生了全身播散和组织学转化。该患者对化疗有反应，已无进展生存2.5年。尽管DFL即使不进行任何治疗通常也呈惰性，但仍可能发生伴有组织学转化的全身播散。该病例提示，对于DFL患者应像通常对淋巴结滤泡性淋巴瘤患者那样进行终身随访。
