Sato Akiyasu, Tsujimura Hideki, Sugiyama Takahiro, Maruyama Satoshi, Yamada Shuhei, Ono Keiko, Wang Xiaofei, Sugawara Takeaki, Ise Mikiko, Itami Makiko, Kumagai Kyouya
Division of Hematology-Oncology, Chiba Cancer Center.
Rinsho Ketsueki. 2016 Mar;57(3):353-8. doi: 10.11406/rinketsu.57.353.
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.
原发性胃肠道滤泡性淋巴瘤（FL）临床表现惰性，许多病例在常规内镜检查时偶然诊断。在此，我们报告3例小肠FL发生大量肠道出血需输血的病例。所有3例患者，上下消化道内镜检查均未发现出血部位。最终，视频胶囊内镜检查发现空肠溃疡性病变，经单气囊或双气囊内镜活检确诊为FL。根据卢加诺系统，各自的临床分期分别为I期、II-1期和II-1期。PET-CT在识别胃肠道病变方面未发挥重要作用。2例患者接受利妥昔单抗单药治疗并获得完全缓解。另1例在停用抗血小板药物治疗后仍在观察中。一般来说，多个白色结节的宏观表现及无症状是胃肠道FL的典型临床表现。然而，本研究表明，有溃疡性病变的患者可能有大出血风险。需要进一步讨论以确定小肠全内镜检查的最佳适应证。
