Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2020; 8(8): 1454-1462
Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1454
Mucosa-associated lymphoid tissue lymphoma simulating Crohn’s disease: A case report
Ieva Stundiene, Vaidota Maksimaityte, Valentina Liakina, Jonas Valantinas
Ieva Stundiene, Vaidota Maksimaityte, Valentina Liakina, Jonas Valantinas, Centre of Hepatology, Gastroenterology and Dietetics, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
Valentina Liakina, Department of Chemistry and Bioengineering, Faculty of Fundamental Science, Vilnius Gediminas Technical University, Vilnius 10223, Lithuania
Valentina Liakina, Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
Author contributions: Stundiene I was the gastroenterologist who followed up the patient; Stundiene I, Maksimaityte V performed patient’s data extraction and literature analysis; Stundiene I, Maksimaityte V, Liakina V wrote the manuscript; Valantinas J revised the manuscript for important intellectual content; all authors approved the final version of the manuscript to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Valentina Liakina, PhD, Reader (Associate Professor), Senior Researcher, Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, 21/27 M. K. Ciurlionio Street, Vilnius 03101, Lithuania. valentina.liakina@santa.lt
Received: February 18, 2020
Peer-review started: February 18, 2020
First decision: March 5, 2020
Revised: March 12, 2020
Accepted: April 4, 2020
Article in press: April 4, 2020
Published online: April 26, 2020
Abstract
BACKGROUND

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.

CASE SUMMARY

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 Helicobacter pylori-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.

CONCLUSION

This case report highlights the clinical relevance of knowledge and awareness of marginal zone lymphoma simulating CD.

Keywords: Crohn disease, Mucosa-associated lymphoid tissue lymphoma, Rare diagnosis, Gastrointestinal diseases, Thiopurines, Case report

Core tip: Mucosa-associated lymphoid tissue (MALT) lymphoma and Crohn‘s disease require different treatments, but both diseases can cause similar gastrointestinal symptoms and have no definitive diagnostic tests. The goal of this case report is to promote the more attentive attitude of gastroenterologists to the rare cases of lymphomas. In the presented case of a 52-year-old patient with a previous diagnosis of the small intestine Crohn's disease and good response to the corresponding treatment, the MALT lymphoma had a rare presentation form–an ulcer, while most MALT lymphomas appear as a mass. This circumstance has made it very difficult to make a correct diagnosis.