Published online Sep 16, 2013. doi: 10.4253/wjge.v5.i9.446
Revised: July 18, 2013
Accepted: August 4, 2013
Published online: September 16, 2013
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.
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.