Intestine - MALT Lymphoma
Comments: A 76 yo W presented with 6 months of intermittent abdominal pain and a 50 pound weight loss. Her symptoms would recur and relapse. She had recently moved from Albania and presented to the MGH ED. For the initial evaluation, she underwent an abdominal CT scan. There were three findings. First, pneumobilia was demonstrated. Second, there were fluid filled and dilated loops, but there was no frank bowel obstruction. Third, the scan demonstrated a 5 x 5 cm mass in the distal ileum.
This CT finding was examined in more detail via colonoscopy. After passing the ileocecal valve, seen here, the base of the cecum was identified by locating the appendiceal orifice. Intubation of the terminal ileum was accomplished without difficulty, and a large mass was identified immediately within the TI. This was exophytic but non-ulcerated. To obtain tissue for definitive pathologic diagnosis, biopsies were taken with conventional forceps. The mass was firm in character, and there was no pillow sign. There was minimal bleeding after the biopsy.
Histopathologic examination of the biopsy specimen with H&E staining showed a diffuse infiltrate of large plasmacytic cells. On high power view, intranuclear eosinophilic inclusions known as Dutcher bodies were readily identified. Immunohistochemical staining revealed that the cells were diffusely positive for both CD45 and CD20. The monoclonal nature of the cells was confirmed by in situ hybridization which demonstrated strong kappa staining in the cells with only occasional lambda positive cells. Overall the findings were consistent with an extranodal marginal zone lymphoma (aka MALT lymphoma) with extensive plasmacytic differentiation.
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Evan S. Dellon, MD G.I. Fellow University of North Carolina Field Willingham, MD, MPH G.I. Fellow Massachusetts General Hospital Chad P. Soupir, MD G.I. Fellow Massachusetts General Hospital Hani Y. Abdallah, MD G.I. Fellow Beth Israel Deaconess Medical Center Courtney E. Barancin, MD Faculty University of Wisconsin Hospitals and Clinics Jonathan M Buscaglia, MD Instructor of Medicine Johns Hopkins Medical Center Alejandra I. Castillo-Roth, MD SUNY Downstate Medical Center Christopher J. DiMaio, MD G.I. Fellow Brigham and Women's Hospital Daniel K. Mullady, MD Brigham and Women's Hospital Massachusetts General Hospital Gottumukkala S. Raju, M.D. Director of Endoscopy University of Texas Medical Branch |
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Citation: Dellon, ES & Willingham, F. & Soupir, CP & Abdallah, HY & Barancin, CE & Buscaglia, JM & Castillo-Roth, AI & DiMaio, CJ & Mullady, DK & Raju, GS (Aug 21 2007). Intestine - MALT Lymphoma. The DAVE Project. Retrieved Sep, 4, 2010, from http://daveproject.org/viewfilms.cfm?film_id=653 Times viewed since Feb 2006: 8397 |
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