Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2022; 14(3): 176-182
Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.176
Mucosa-associated lymphoid tissue lymphoma in the terminal ileum: A case report
Vitor Lauar Pimenta de Figueiredo, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Cristiano Claudino Oliveira, Eduardo Guimarães Hourneaux de Moura
Vitor Lauar Pimenta de Figueiredo, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-010, Brazil
Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Cristiano Claudino Oliveira, Eduardo Guimarães Hourneaux de Moura, Unidade Morumbi-Rede D`Or, Hospital São Luiz, São Paulo 05605-050, Brazil
Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, São Paulo 05403-000, Brazil
Author contributions: de Figueiredo VLP, Ribeiro IB, and de Moura EGH performed the data curation; Ribeiro IB and de Moura DTH contributed to the formal analysis; Ribeiro IB and de Moura EGH performed the investigation; de Moura EGH contributed to the supervision; de Figueiredo VLP and Ribeiro IB contributed to the writing of the original draft; Ribeiro IB contributed to the writing of the review and editing.
Informed consent statement: The work described has been conducted in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). Informed consent for publication of this case was obtained from the patient’s daughter (witnessed by two physicians).
Conflict-of-interest statement: All other 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: Igor Braga Ribeiro, MD, Doctor, Research Assistant, Research Scientist, Surgeon, Unidade Morumbi-Rede D`Or, Hospital São Luiz, Rua Engenheiro Oscar Americano, 840-Jardim Guedala, São Paulo 05605-050, Brazil. igorbraga1@gmail.com
Received: July 31, 2021
Peer-review started: July 31, 2021
First decision: September 29, 2021
Revised: October 5, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: March 16, 2022
Abstract
BACKGROUND

The lymphoma of the mucosa-associated lymphoid tissue (MALT) is predominantly found in the stomach. The few cases reported in the literature of MALT lymphomas affecting the ileum are in patients who are already symptomatic and with clear advanced endoscopic findings. We present the first case of an asymptomatic female patient who underwent colonoscopy as a routine examination with the findings of an ulcer in the distal ileum region, which histopathological examination and associated immunohistochemistry revealed the diagnosis of MALT lymphoma.

CASE SUMMARY

A 57-year-old asymptomatic female patient underwent a colonoscopy exam for screening. The examination revealed an ulcer of medium depth with well-defined borders covered by a thin layer of fibrin and a halo of hyperemia in the distal ileum portion. Findings are nonspecific but may signal infections by viruses, protozoa, and parasites or inflammatory diseases such as Crohn's disease. Biopsies of the ulcer were taken. The anatomopathological result revealed an atypical diffuse lymphocytic infiltrate of small cells with a characteristic cytoplasmic halo of marginal zone cells. The immunohistochemical study was performed and the results demonstrated a negative neoplastic infiltrate for the expression of cyclin D1 and cytokeratin AE1/AE3 and a positive for BCL60 in the germinal center. The test also revealed CD10 positivity in the glandular epithelium and germinal center of a reactive follicle with dual-labeling of CD20 and CD3 demonstrating the B lymphocyte nature of the neoplastic infiltrate. In BCL2 protein labeling, the neoplastic infiltrate is strongly positive with a negative germinal center. The findings are consistent with immunophenotype B non-Hodgkin's lymphoma, better classified as extranodal MALT. The patient was treated with chemotherapy and showed complete regression of the disease, as evidenced by colonoscopy performed after treatment.

CONCLUSION

MALT lymphomas in the terminal ileum are extremely rare and only 4 cases have been reported in the literature. Given the low sensitivity and specificity of endoscopic images in these cases, the pathology can be confused with other important differential diagnoses such as inflammatory diseases or infectious diseases and which makes the biopsy important, even in asymptomatic patients, paired with anatomopathological analysis and immunohistochemistry which is the gold standard for correct diagnosis.

Keywords: Mucosa-associated lymphoid tissue lymphoma, Ileum, Colonoscopy, Diagnosis, Biopsy, Case report

Core Tip: Mucosa-associated lymphoid tissue (MALT) lymphoma is predominantly found in the stomach. Only a few cases of MALT lymphomas affecting the ileum have been published in the literature and these patients already had clear symptoms and endoscopic findings. We present a rare case of MALT lymphoma in the terminal ileum in an asymptomatic patient who underwent the examination for age screening.