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Updated: Nov 15, 2025
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The Pillow Sign: Is It Always Benign?
Sujay Alvencar1, Erik Holzwanger1, Rohit Dhingra1
1Tufts Medical Center, Boston, MA.
ACG Case Reports Journal
|March 3, 2021
Summary
Colonic mucosa-associated lymphoid tissue (MALT) lymphoma is rare, presenting challenges in diagnosis and treatment. This case highlights diagnostic mimicry and management complexities in extragastric MALT lymphoma.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Mucosa-associated lymphoid tissue (MALT) lymphoma typically occurs in the stomach.
- Extragastric MALT lymphomas are rare, with colonic MALTomas being exceptionally uncommon.
- Optimal management strategies for colonic MALT lymphoma are not standardized.
Observation:
- A case of colonic MALT lymphoma was diagnosed during colonoscopy.
- The lesion mimicked a benign lipoma and presented with the 'pillow sign'.
- The patient had a history of chronic hepatitis B.
Findings:
- Despite initial antimicrobial and endoscopic treatment, the colonic MALT lymphoma recurred.
- Chronic hepatitis B infection complicated treatment options, specifically delaying rituximab therapy until viral eradication.
Implications:
- This case underscores the diagnostic challenges of extragastric MALT lymphomas.
- It highlights the need for tailored treatment approaches considering patient-specific factors like viral infections.
- Further research into standardized management protocols for colonic MALT lymphoma is warranted.
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