Case Report
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World J Gastroenterol. Mar 14, 2022; 28(10): 1078-1084
Published online Mar 14, 2022. doi: 10.3748/wjg.v28.i10.1078
Successful treatment of an enormous rectal mucosa-associated lymphoid tissue lymphoma by endoscopic full-thickness resection: A case report
Fang-Yuan Li, Xiao-Long Zhang, Qi-De Zhang, Yao-Hui Wang
Fang-Yuan Li, Xiao-Long Zhang, Qi-De Zhang, Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of TCM, Nanjing 210046, Jiangsu Province, China
Yao-Hui Wang, Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of TCM, Nanjing 210046, Jiangsu Province, China
Author contributions: Zhang QD conceived and performed the operation; Wang YH analyzed and interpreted the histopathological and immunohistochemical results; Li FY collected the clinical information and wrote the manuscript; Zhang XL revised the manuscript.
Supported by National Natural Science Foundation of China, No. 82004298.
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 conflicts 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:
Corresponding author: Xiao-Long Zhang, PhD, Lecturer, Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of TCM, No. 155 Hanzhong Road, Qinhuai District, Nanjing 210046, Jiangsu Province, China.
Received: July 17, 2021
Peer-review started: July 17, 2021
First decision: September 5, 2021
Revised: September 15, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: March 14, 2022

Colorectal mucosa-associated lymphoid tissue lymphoma (MALToma), a rare kind of nongastric MALToma, lacks consensus on its endoscopic features and standard therapies. According to previous studies on the clinical characteristics and outcomes of colorectal MALToma, endoscopic resection remains a good therapeutic strategy.


A 71-year-old woman suffered intermittent hematochezia for 1 mo, accompanied with abdominal pains but without weight loss, fever, chills or fatigue. Colonoscopy showed a massive hemispheric mass with rough and hyperemic mucosa in the lower rectum. Narrow-band imaging magnifying endoscopy detected some branching abnormal blood vessels and disappearance of glandular structure, which was similar with the tree-like appearance sign in gastric MALToma. Endoscopic ultrasonography revealed the lesion to be hypoechoic, boundary-defined, and echo uniform inside, originating from the muscularis propria. Abdominal enhanced computed tomography (CT) demonstrated a soft tissue mass with defined boundary. No enlarged superficial lymph nodes were detected by B-mode ultrasound. C13-urea breath test and serum Helicobacter pylori antibody were both negative. The patient underwent endoscopic full-thickness resection. Postoperative pathological analysis indicated colorectal MALToma. The patient remained asymptomatic after discharge, and follow-up positron emission tomography–CT and colonoscopy showed no residual lesion, remnants or lymph node metastasis.


This case provides new information on the specific endoscopic features of colorectal MALToma and an alternative treatment for patients.

Keywords: Mucosa-associated lymphoid tissue lymphoma, Endoscopic full-thickness resection, Endoscopic minimally invasive surgery, Endoscopy, Case report

Core tip: Colorectal mucosa-associated lymphoid tissue lymphoma (MALToma) is considered a rare type of nongastric MALToma with no specific endoscopic features and no standard therapeutic strategies. We present a case of a large rectal MALToma that exhibited the tree-like appearance (TLA) sign and was successfully treated by modified endoscopic full-thickness resection (EFTR). This case highlights that TLA sign tends to be a specific feature of colorectal MALToma and EFTR seems to be a feasible and economical choice for the treatment of large colorectal MALToma.