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Synchronous indolent primary gastrointestinal lymphomas managed successfully with conservative measures
Andrew S Brohl1, Joo Y Song, Ron Lieberman
11Medical Oncology Branch and 2Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; and 3SAIC-Frederick, Frederick, MD.
American Journal of Therapeutics
|October 25, 2011
Summary
A 65-year-old man had two distinct gastrointestinal lymphomas, gastric extranodal marginal zone lymphoma and ileal follicular lymphoma. Treatment resolved the gastric lymphoma but not the ileal one, despite a shared molecular origin.
Area of Science:
- Gastroenterology
- Hematology
- Oncology
Background:
- Gastrointestinal lymphomas are rare, with extranodal marginal zone lymphoma and follicular lymphoma being distinct subtypes.
- Helicobacter pylori infection is a known risk factor for gastric extranodal marginal zone lymphoma.
- Simultaneous occurrence of distinct lymphomas in different gastrointestinal segments is exceptionally rare.
Observation:
- A 65-year-old male presented with epigastric pain and guaiac-positive stool, indicative of gastrointestinal bleeding.
- Endoscopy revealed abnormalities in the gastric antrum and terminal ileum.
- Biopsies confirmed two distinct lymphomas: gastric extranodal marginal zone lymphoma (associated with H. pylori) and ileal follicular lymphoma.
Findings:
- Treatment with H. pylori eradication resolved the gastric extranodal marginal zone lymphoma.
- The ileal follicular lymphoma persisted after H. pylori eradication therapy.
- Molecular analysis revealed a common IgH rearrangement in both lymphomas, suggesting a shared clonal origin.
Implications:
- This case highlights the differential response of distinct gastrointestinal lymphomas to H. pylori eradication therapy.
- The shared molecular origin suggests a complex clonal evolution process in the development of synchronous gastrointestinal lymphomas.
- Understanding these unique presentations is crucial for refining diagnostic and therapeutic strategies for indolent gastrointestinal non-Hodgkin lymphomas.
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