Clin Endosc.  2018 Jul;51(4):388-392. 10.5946/ce.2017.114.

Primary Colonic Follicular Lymphoma Presenting as Four Diminutive Sessile Polyps Found Incidentally During Colonoscopy

• Jin S
• Lee HS
• Jeong JY
• Jo YW

• KMID: 2419713
• DOI: http://doi.org/10.5946/ce.2017.114

Abstract

Follicular lymphomas, which typically arise in the lymph nodes with spleen, liver, and bone marrow involvement, have generally low occurrence rates in Asian countries as compared with Western countries. Follicular lymphomas of the gastrointestinal tract are rare, and primary colonic follicular lymphomas are particularly rare compared with others found in the small intestine and duodenum. Colonoscopic imaging of colonic lymphomas, including follicular lymphoma, may reveal mucosal ulcerations, erosions, indurations, polypoid mass-like lesions, and diffuse mucosal nodularity. Herein, we report a unique case of a follicular lymphoma of the transverse colon characterized by four sessile diminutive polyps located intermittently with multiple lymph node involvement in a 62-year-old man.

Keyword

Lymphoma, follicular; Colon; Diminutive polyps

MeSH Terms

Asian Continental Ancestry Group
Bone Marrow
Colon*
Colon, Transverse
Colonoscopy*
Duodenum
Gastrointestinal Tract
Humans
Intestine, Small
Liver
Lymph Nodes
Lymphoma
Lymphoma, Follicular*
Middle Aged
Polyps*
Spleen
Ulcer

Figure

• 

  Fig. 1. Colonoscopic findings. (A, B) Sessile polyps in the hepatic flexure and proximal transverse colon were both 2 mm in size. They were removed using forceps. (C-F) Sessile polyps in the proximal and distal transverse colon were 4 and 3 mm in size, respectively. They were resected via endoscopic mucosal resection after injecting saline into the submucosa.

• 

  Fig. 2. Histologic examinations of colonic polyps. (A) Homogeneous small lymphoid cells with irregular nuclei are noted (hematoxylin and eosin staining, ×200). (B) Lymphoid cells are diffusely positive for CD20 (immunohistochemical staining for CD20, ×100).

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  Fig. 3. Positron emission tomography-computed tomography findings. Lymphoma involvement in the spleen and lymph nodes on both sides of the diaphragm is observed.

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  Fig. 4. Histologic examination of the lymph nodes in the left side of the neck. (A) Homogeneous small lymphoid cells with irregular nuclei resembling centrocytes are noted in the follicles. A centroblast is observed (arrow) (hematoxylin and eosin staining, ×400). (B) Lymphoid cells in the follicles are uniformly positive for Bcl-2 (Immunohistochemical staining for Bcl-2, ×100).

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