Case Report
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World J Gastrointest Endosc. Sep 16, 2013; 5(9): 446-449
Published online Sep 16, 2013. doi: 10.4253/wjge.v5.i9.446
Extremely rare case of primary esophageal mucous associated lymphoid tissue lymphoma
Ali Osama Malik, Zahid Baig, Aqeel Ahmed, Nasar Qureshi, Fatima Noor Malik
Ali Osama Malik, Department of Medicine, Robert Wood Johnson University Hospital, Hamilton, NJ 08540, United States
Ali Osama Malik, Department of Cardiovascular Medicine Cleveland Clinic Foundation, Cleveland, OH 44120, United States
Zahid Baig, Department of Medicine, Robert Wood Johnson University Hospital, Hamilton, NJ 08540, United States
Aqeel Ahmed, Department of Pathology, Columbia Presbytirian Hospital, New York, NY 10259, United States
Nasar Qureshi, Department of Pathology QD, Pathology Services, Cranford, NJ 07016, United States
Fatima Noor Malik, Department of Medicine, Robert Wood Johnson University Hospital, Hamilton, NJ 08540, United States
Author contributions: Malik AO and Baig Z wrote the manuscript; Ahmed A and Qureshi N provided feedback on the manuscript and the staining of the biopsy samples; Malik FN provided valuable contribution to the manuscript and also did the conversion of the figures into the required format.
Correspondence to: Dr. Ali Osama Malik, Department of Cardiovascular Medicine Cleveland Clinic Foundation, Euclid Avenue, Cleveland, OH 44120, United States. a_o_malik@hotmail.com
Telephone: +1-609-3720251 Fax: +1-609-3720251
Received: May 24, 2013
Revised: July 18, 2013
Accepted: August 4, 2013
Published online: September 16, 2013
Processing time: 112 Days and 13.2 Hours
Abstract

SJ is a 37-year-old male who presented with one year history of dysphagia, odynophagia and 15 pounds weight loss. He underwent endoscopic evaluation which showed mid esophageal ulcers. It was thought that the cause of the ulcer was the multivitamins and the patient was asked to stop them. Furthermore Esomeprazole therapy was also initiated. Patient’s symptoms persisted but he did not seek any medical attention until about one year later. Meanwhile the patient reported additional 15 pounds of weight loss. We repeated upper endoscopy again which showed evidence of two chronic non bleeding irregular friable ulcerations seen in the mid esophagus, 31 cm from the incisors. Biopsies and frozen section were taken and sent for assessment to the Pathology lab. Immunoperoxidase studies on frozen sections showed the presence of IgM and for most plasma cells IgG. The microscopic and histologic findings were consistent with mucous associated lymphoid tissue lymphoma with plasmocytic differentiation. Computed tomographic scan done showed no evidence of spread to adjacent structures. The patient was referred to oncology and several cycles of radiation and Rituximab therapy were initiated which cured the disease. Subsequent endoscopies with blind biopsies were done which were negative for any neoplastic process.

Keywords: Lymphoma; Mucous associated lymphoid tissue; Esophagus

Core tip: This is a case of a 37-year-old gentleman presenting with chronic esophageal ulcers. Endoscopic biopsy samples were taken. Immunohistochemistry and hematoxylin and eosin staining of the biopsy samples were consistent with mucous associated lymphoid tissue (MALT) lymphoma. There was no sign of disease process in the stomach, and radiological studies revealed no evidence of metastasis. In consideration of these findings a diagnosis of primary esophageal MALT lymphoma was made, which is an extremely rare occurrence. On the basis of our experiences we recommend keeping primary esophageal MALT lymphoma in the differential diagnosis of chronic esophageal ulcers that are resistant to conservative management.