Kitabatake Hiroyuki, Nagaya Tadanobu, Tanaka Naoki, Ota Hiroyoshi, Sano Kenji, Asano Naoko, Suga Tomoaki, Nakamura Yoshiyuki, Akamatsu Taiji, Tanaka Eiji
Department of Gastroenterology, Shinshu University Graduate School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan.
Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan.
Clin J Gastroenterol. 2017 Feb;10(1):79-85. doi: 10.1007/s12328-016-0697-9. Epub 2016 Nov 21.
A 71-year-old Japanese man was diagnosed as having stage I primary follicular lymphoma (FL) of the duodenum according to Lugano International Conference Classification and began receiving annual checkups. Endoscopic examination disclosed white villi swelling with depressed red mucosal lesions. Biopsy specimens from the area of white villi exhibited histopathological features that met the diagnostic criteria for low-grade FL. The depressed red lesions gradually enlarged over six years of follow-up. A biopsy of the white villi swelling revealed distinct well-circumscribed follicles with attenuated mantles in the lamina propria that were positive for CD20, bcl-2, and CD10. Histological findings from the depressed red lesions at 5.5 years after the initial diagnosis were compatible for FL. However, biopsy specimens 6 months later obtained from the same lesions showed a mixture of larger mononuclear cells. These follicular cells were positive for CD20 and bcl-2, but not for CD10, indicating the presence of diffuse large B-cell lymphoma (DLBCL). This case shows altered endoscopic findings in the course of DLBCL development from FL. When depressed red lesions are detected in the background of white villi swelling, repeated biopsies should be performed from both lesions.
一名71岁的日本男性根据卢加诺国际会议分类被诊断为十二指肠I期原发性滤泡性淋巴瘤（FL），并开始接受年度检查。内镜检查发现白色绒毛肿胀，伴有凹陷的红色黏膜病变。白色绒毛区域的活检标本显示出符合低级别FL诊断标准的组织病理学特征。在六年的随访中，凹陷的红色病变逐渐扩大。对白色绒毛肿胀部位进行活检，显示固有层有界限分明、边界清晰的滤泡，其套区变薄，CD20、bcl-2和CD10呈阳性。初次诊断5.5年后凹陷红色病变的组织学表现符合FL。然而，6个月后从同一病变部位获取的活检标本显示有较大单核细胞混合存在。这些滤泡细胞CD20和bcl-2呈阳性，但CD10呈阴性，提示存在弥漫性大B细胞淋巴瘤（DLBCL）。该病例显示了从FL发展为DLBCL过程中内镜表现的变化。当在白色绒毛肿胀背景下检测到凹陷红色病变时，应从两个病变部位重复进行活检。
