Dias Emanuel, Andrade Patrícia, Cardoso Hélder, Gullo Irene, Fonseca Elsa, Macedo Guilherme
Gastrenterology , Centro Hospitalar Universitário de São João, Portugal.
Gastroenterology, Centro Hospitalar Universitário de São João.
Rev Esp Enferm Dig. 2023 Jan;115(1):43-44. doi: 10.17235/reed.2022.8943/2022.
An asymptomatic 38-year-old male with no significant previous medical history performed routine laboratory studies that revealed iron-deficiency anemia. Esophagogastroduodenoscopy and colonoscopy were unremarkable and he undergone videocapsule endoscopy that revealed multiple small polyps along jejunum and ileum. Double-balloon enteroscopy confirmed the presence of scattered small whitish nodules and small polyps carpeting segments of jejunal mucosal and sometimes forming conglomerates with a nodular appearance. Histopathological examination showed lamina propria expansion by neoplastic follicles, predominantly composed by small lymphoid cells that, by immunohistochemistry, showed expression of CD20, CD10 and bcl-2. Computed tomography scan of abdomen and pelvis did not reveal systemic involvement, consistent with primary small bowel follicular lymphoma. Chemotherapy was started and, at reevaluation enteroscopy, although nodular jejunal segments persisted, biopsies did not show involvement by lymphoproliferative disease, which was interpreted as complete remission. Periodic clinical and biochemical evaluation and annual enteroscopic surveillance was maintained and, after three years, local recurrence of low-grade follicular lymphoma was detected. As previously, there was no evidence of systemic involvement and the decision was to maintain close surveillance. After one year, the patient remains asymptomatic and without evidence of disease progression. This case illustrates the essential role of balloon-assisted enteroscopy for diagnosis and surveillance of primary small bowel follicular lymphoma.
一名38岁无症状男性，既往无重大病史，进行常规实验室检查时发现缺铁性贫血。食管胃十二指肠镜检查和结肠镜检查均无异常，随后他接受了视频胶囊内镜检查，发现空肠和回肠有多个小息肉。双气囊小肠镜检查证实存在散在的小白色结节以及覆盖空肠黏膜段的小息肉，有时形成结节状团块。组织病理学检查显示肿瘤性滤泡导致固有层扩张，主要由小淋巴细胞组成，免疫组化显示其表达CD20、CD10和bcl-2。腹部和盆腔计算机断层扫描未发现全身受累，符合原发性小肠滤泡性淋巴瘤。开始化疗，再次评估小肠镜检查时，尽管空肠结节段仍然存在，但活检未显示有淋巴增殖性疾病累及，这被解释为完全缓解。维持定期的临床和生化评估以及每年的小肠镜监测，三年后，检测到低度滤泡性淋巴瘤局部复发。与之前一样，没有全身受累的证据，决定继续密切监测。一年后，患者仍无症状，且无疾病进展的证据。该病例说明了气囊辅助小肠镜在原发性小肠滤泡性淋巴瘤诊断和监测中的重要作用。
