Stundiene Ieva, Maksimaityte Vaidota, Liakina Valentina, Valantinas Jonas
Centre of Hepatology, Gastroenterology and Dietetics, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania.
World J Clin Cases. 2020 Apr 26;8(8):1454-1462. doi: 10.12998/wjcc.v8.i8.1454.
Differential diagnosis between extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and inflammatory bowel disease is mainly based on histopathologic evaluation of intestinal biopsies, although there is no single definitive diagnostic investigation and that circumstance can lead to misdiagnosis in particular cases. Herein we present a rare, ulcerative form of marginal zone lymphoma which mimics the Crohn's disease (CD) of upper digestive tract.
A 50-year-old man was presented with recurrent episodes of malaise and melena also weight loss. Enteroscopy of the small bowel demonstrated an ulcer in the jejunum. Microscopically, biopsies showed lymphoplasmacytic infiltrate. Diagnosis of CD was made. Primary treatment consisted of prednisone and azathioprine and was followed by azathioprine 100 mg per day with good clinical response in the following 2 years until relapse. At this time the results of endoscopic biopsies derived from proximal wall of stomach revealed -negative marginal zone lymphoma of the gastric fundus. Immunophenotyping confirmed atypical CD20-positive cell population. Based on these biopsies, marginal zone lymphoma of mucosa-associated lymphoid tissue was diagnosed. Unfortunately, the contact with the patient was lost until one year later he was hospitalized with nausea, vomiting and severe pain because of gastrointestinal perforation. Four months later after laparotomy, the patient was treated with a course of chemotherapy. Complete remission was observed following 6 cycles of treatment.
This case report highlights the clinical relevance of knowledge and awareness of marginal zone lymphoma simulating CD.
黏膜相关淋巴组织结外边缘区淋巴瘤与炎症性肠病的鉴别诊断主要基于肠道活检的组织病理学评估，尽管没有单一的确定性诊断检查，这种情况在某些病例中可能导致误诊。在此，我们报告一种罕见的溃疡性边缘区淋巴瘤，其酷似上消化道克罗恩病（CD）。
一名50岁男性出现反复不适、黑便及体重减轻。小肠肠镜检查显示空肠有一处溃疡。显微镜下，活检显示淋巴浆细胞浸润。诊断为CD。初始治疗包括泼尼松和硫唑嘌呤，随后每天服用100mg硫唑嘌呤，在接下来的2年里临床反应良好，直至复发。此时，取自胃近端壁的内镜活检结果显示胃底边缘区淋巴瘤阴性。免疫表型分析证实存在非典型CD20阳性细胞群。基于这些活检，诊断为黏膜相关淋巴组织边缘区淋巴瘤。不幸的是，与患者失去了联系，直到一年后他因胃肠道穿孔伴恶心、呕吐和剧痛住院。剖腹手术后四个月，患者接受了一个疗程的化疗。6个周期的治疗后观察到完全缓解。
本病例报告强调了认识和了解模拟CD的边缘区淋巴瘤的临床意义。
