Duodenal Lymphoma
Duodenal Lymphoma

Video Endoscopic Sequence 1 of 24.

Duodenal Lymphoma


Primary Duodenal Lymphoma presenting as Obstructive Jaundice.

This is a 64 year-old male, that has been referred to our endoscopic unit due to a jaundice. The endoscopic image is the second part of the duodenum tha is infiltrated with malignant tissue. Meaning that this infiltration distorts the anatomy of the major papilla, causing obstructive jaundice. The abdominal
ultrasound shows common bile-duct dilatation.

Duodenal Lymphoma

Download the video clips by clicking on the endoscopic images, if you wish to observe in full screen, wait to be downloaded complete then press Alt and Enter for Windows media, Real Player Ctrl and 3. Configure the windows media in repeat is optimal. All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode. 

 

 

 

Endoscopy of Duodenal Lymphoma

Video Endoscopic Sequence 2 of 24.

Endoscopy of Duodenal Lymphoma

Several ulcerated tumors are observed through the
duodenum.

Malignant lymphoma of mucosa-associated lymphoid tissue (MALT) can arise in a variety of anatomical sites. The majority of these tumors arise in the stomach, with fewer than 30% arising in the small intestine. Primary duodenal MALT lymphoma is a very rare neoplasm. There are very few cases of duodenal MALT lymphoma reported in the literature.

 

 

 

 

Duodenal Lymphoma

Video Endoscopic Sequence 3 of 24.

Image of Duodenal Lymphoma

H pylori infection has been associated with gastric MALT lymphomas. The role of H pylori in duodenal MALT lymphoma is unclear. Therapy of H pylori infection has
been correlated with tumour regression.

 

 

 

 

Duodenal Lymphoma

Video Endoscopic Sequence 4 of 24.

Endoscopic Image of Duodenal Lymphoma

This lesion is seen at the end of the fourth portion of the duodenum bordering the Treitz angle.


In 1993, Wotherspoon and colleagues, described the remarkable observation of regression of marginal zone B -cell lymphoma upon eradication of H pylori using antibiotics. Since then, multiple other medical centers have reported the same phenomenon, with response rates
ranging from 60% to 90%.

The interval to histologic regression may be prolonged, with a range of 1 to 25 months and a median of 5 months. Features associated with failure of regression include a component of large B-cell lymphoma, invasion beyond the submucosa, spread beyond the stomach, and chromosomal
abnormalities, such as t and t. In cases that are histologically negative for lymphoma following H pylori eradication, clonal B cells can be detected by polymerase chain reaction up to several years later.

 

 

 

 

Duodenum Lymphoma

Video Endoscopic Sequence 5 of 24.

Duodenum Lymphoma

The most common extranodal site is the gastrointestinal tract. Gastrointestinal lymphomas make up approximately one-third to one-half of extranodal lymphomas, approximately 12 per cent to 13 per cent of all lymphomas, and approximately 1 per cent of all gastrointestinal
neoplasms. The stomach is the most common site for lymphomas of the gastrointestinal tract, accounting for 50 per cent to 60 per cent of cases, small intestine 20 per cent to 30 per cent, and colon 10 per cent to 20 per cent. The duodenum is the least common site, making up only
approximately 5 per cent of gastrointestinal lymphomas, and is rarely reported as a site of incidence separate from the small intestine.

 

 

 

 

Duodenum Lymphoma

Video Endoscopic Sequence 6 of 24.

Endoscopic image of Duodenum Lymphoma

In summary, duodenal lymphoma is an uncommon malignancy that may present with elective or emergent operative indications. Cell type, grade, and presence of disseminated disease are the principal determinants of therapy and prognosis. Bleeding from high-grade lesions
requires early and aggressive operative therapy. Lower grade malignancies such as follicular lymphoma are effectively treated with surgery and radiation when localized. MALT is treated principally with medical measures to eradicate H. pylori and radiation or chemotherapy for persistent lesions..

 

 

 

 

Video Endoscopic Sequence 7 of 24.

Endoscopy of Duodenum Lymphoma

Lymphomas arising in extranodal sites are intriguing. The types of lymphomas encountered vary widely from one extranodal site to another. For many types of extranodal lymphomas, there are distinctive clinicopathologic features, sometimes including association with an underlying
immunodeficiency syndrome, autoimmune disease, infection, or other immunologic disorder, or a predilection to affect patients of certain ethnic origins. Presented below is a review of lymphomas that are encountered most often in extranodal sites.

 

 

 

 

Video Endoscopic Sequence 8 of 24.

Video Endoscopic Image of Duodenum Lymphoma

 

 

 

 

Video Endoscopic Sequence 9 of 24.

Video Endoscopic Image of Duodenum Lymphoma

 

 

 

 

Video Endoscopic Sequence 10 of 24.

Video clip of the computed tomography

Computed tomography (CT) has wide application in the initial evaluation of patients with lymphoma. The technique has been so successful that, in many centers, it is the first and often sole radiologic examination for these patients. Attention has usually been directed toward the evaluation
of the presence of adenopathy and the assessment of solid organ involvement.

 

 

 

 

Video Endoscopic Sequence 11 of 24.

Contrast-enhanced CT scan of abdomen of a Duodenum Lymphoma

 

 

 

 

Video Endoscopic Sequence 12 of 24.

Contrast- enhanced CT scan of abdomen

 

 

 

 

Video Endoscopic Sequence 13 of 24.

Contrast- enhanced CT scan of abdomen

 

 

 

Video Endoscopic Sequence 14 of 24.

Contrast- enhanced CT scan of abdomen

 

 

 

Video Endoscopic Sequence 15 of 24.

Contrast- enhanced CT scan of abdomen

 

 

 

Video Endoscopic Sequence 16 of 24.

Contrast- enhanced CT scan of abdomen

 

 

 

Video Endoscopic Sequence 17 of 24.

Contrast- enhanced CT scan of abdomen

 

 

 

Video Endoscopic Sequence 18 of 24.

Contrast- enhanced CT scan of abdomen

 

 

 

Video Endoscopic Sequence 19 of 24.

 

 

 

 

Video Endoscopic Sequence 20 of 24.

 

 

 

 

Video Endoscopic Sequence 21 of 24.

Linfoma MALT Gastroduodenal

Se puede definir como Linfoma MALT o Maltoma a la proliferación neoplásica monoclonal de linfocitos B que infiltran las glándulas gástricas, con típicas lesiones linfoepiteliales.

El linfoma MALT es el exponente que se desarrolla dentro del último grupo expuesto, se define además como Maltoma, constituyendo la proliferación neoplásica monoclonal de linfocitos B que infiltran las glándulas gástricas, con típicas lesiones linfoepiteliales.

Mayores detalles descargar el video presionando la imagen endoscópica.

Todas las imágenes endoscópicas de este atlas contienen un Video.

 

 

 

Video Endoscopic Sequence 22 of 24.

LCD 20


CD-20:positive +++

 

 

 

 

Video Endoscopic Sequence 23 of 24.

 

 

 

 

Video Endoscopic Sequence 24 of 24.

LCITOQUERATINE

CITOQUERATINE (AE1/AE3):NEGATIVE IN TUMOUR.
POSITIVA +++ IN NON TUMOR GLAND

 

 

 

Gastroduodenal MALToma

Video Endoscopic Sequence 1 of 12.

Gastroduodenal MALToma

Mucosa-Associated Lymphoid Tissue Lymphoma

Endoscopy shows nodular erosions with necrotic material of the gastric body and fundus as well as larger irregular ulcers of the third portion of duodenus.

It has long been known that the stomach is the most common location of lymphoma within the gastrointestinal tract. However, it is only in the past few decades that the reason for this fact has been found. The discovery of gastric Helicobacter pylori infection and its role in the pathogenesis of chronic gastritis, lymphoma and probably gastric carcinoma has revolutionized our definition of malignancy. The concept of a pathway of lymphoid hyperplasia (chronic gastritis) leading to lymphoid “dysplasia” (atypical lymphoid infiltrates) that further evolves into a proliferation that fulfils criteria for malignancy (lymphoma) has been compared to the adenoma-carcinoma sequence in epithelial neoplasia.

 

 

 

 

 

Video Endoscopic Sequence 2 of 12.

Gastroduodenal MALT lymphoma

Endoscopy shows large erosion, biopsies were positive to be a maltoma.

Mucosa-Associated Lymphatic Tissue (MALT) Lymphoma is a very rare type of Non-Hodgkin’s Lymphoma. MALT tissue is lymphatic tissue that is found in the stomach, lungs, thyroid, salivary glands, intestines, and eyes, so it is classified as "extranodal" (out of the nodes). MALToma typically results from a mutation of B-cells in this extranodal tissue. It is an indolent, or slow growing, cancer.

MALToma can arise in any organ with MALT tissue. Though the stomach is the affected organ in most cases (2 out of 3), the lungs, thyroid, and eyes can be involved also. This cancer is associated with several diseases and conditions, such as the bacteria Helicobacter pylori, Sjogren Syndrome, Celiac Disease, Chron’s Disease, or Hashimoto Thyroiditis.

 

 

 

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 3 of 12.

Duodenal MALT lymphoma

This lesion is located in the third portion of the duodenum.

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 4 of 12.

Duodenal MALT lymphoma

Third portion of the duodenum

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 5 of 12.

Endoscopy Shows large and deep ulcers

The concept of mucosa-associated lymphoid tissue
(MALT) lymphomas was introduced by Isaacson and
Wright [ Cancer 1983; 52:1410–1416[CrossRef][Medline]
in 1983. After more than 20 years of clinical research
MALT lymphomas are now recognized as a distinct
subtype of non-Hodgkin’s lymphoma (NHL) with unique
pathogenic, histological, and clinical features. Although this
subtype of NHL occurs frequently, optimal management
remains elusive.

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 6 of 12.

Endoscopy shows multiple large and deep ulcers in the
third portion of the duodenum.

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 7 of 12.

Again the video endoscopy displays several large and deep ulcers.

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 8 of 12.

Differential Diagnosis: Gastritis or Low Grade MALT
Lymphoma?.

Distinguishing severe chronic gastritis from low grade
MALT lymphoma is the most common diagnostic dilemma
in gastric biopsies containing dense lymphocytic infiltrates.
In practice, the distinction between the two can often be
easily accomplished histologically. In more difficult cases,
immunohistochemistry and PCR analysis may be required
to arrive at the correct diagnosis. In the following
discussion, bare in mind that lymphoma occurs in a
background of chronic H. pylori related gastritis.
Therefore, a mixture of gastritis and lymphoma in biopsies
is the rule, not the exception.

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 9 of 12.

Endoscopic view of a malignant picture involving the
third part of the duodenum.

H pylori infection has been associated with gastric MALT
lymphomas. The role of H pylori in duodenal MALT
lymphoma is unclear. Therapy of H pylori infection has
been correlated with tumour regression.

 

Duodenal MALT lymphoma

Video Endoscopic Sequence 10 of 12.

Video Endoscopic Sequence 11 of 12.

Video Endoscopic Sequence 12 of 12.

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 1 of 7.

Duodenal Lymphoma B cells.

The pylorus is observed, the duodenal bulb contains
several nodules.

 

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 2 of 7.

Duodenal Lymphoma B cells.

The duodenal bulb is infiltrated and ulcerated there are
multiple tumors that thickening the lumen.

 

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 3 of 7.

The image and the video display the third portion of the
duodenus.
This image displays several tumors varying in size length.

 

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 4 of 7.

Duodenal Lymphoma B cells.

 

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 5 of 7.

The lumen is compromised by marked thickening and
crowding of the circular folds.

 

 

 

 

 

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 6 of 7.

There are several sub mucosal tumors.

 

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 7 of 7.

Stomach retroflexed view.

The image and the video display multiple small nodules.

 

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