Primary gastrointestinal follicular lymphoma of the small intestine with massive hemorrhage: a report of three cases

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Other Title
  • 大量出血を来した3例の小腸原発濾胞性リンパ腫
  • 症例報告 第2回日本血液学会関東甲信越地方会 優秀演題 大量出血を来した3例の小腸原発濾胞性リンパ腫
  • ショウレイ ホウコク ダイ2カイ ニホン ケツエキ ガッカイ カントウ コウシンエツチホウカイ ユウシュウ エンダイ タイリョウ シュッケツ オ キタシタ 3レイ ノ ショウチョウ ゲンパツ ロホウセイ リンパシュ

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Abstract

Primary gastrointestinal follicular lymphoma (FL) has an indolent clinical presentation and many of cases are diagnosed incidentally during routine endoscopic examinations. Herein, we present 3 cases with FL of the small intestine developed massive intestinal hemorrhage that necessitated blood transfusion. In all three patients, upper and lower endoscopic examinations failed to detect the bleeding sites. Eventually, video capsule endoscopies identified ulcerative lesions in the jejunum and biopsies using single- or double-balloon endoscopy confirmed the FL diagnosis in our three cases. The respective clinical stages according to the Lugano system were I, II-1 and II-1. PET-CT did not play a significant role in identifying the gastrointestinal lesions. Two patients received rituximab monotherapy and achieved a complete response. The other remains under observation after termination of antiplatelet drug therapy. Generally, the macroscopic appearance of multiple whitish nodules and the absence of symptoms represent the typical clinical picture of gastrointestinal FL. However, this study demonstrates that patients with ulcerative lesions may be at risk for massive bleeding. Further discussion is required to determine the optimal indications for total endoscopic examination of the small intestine.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 57 (3), 353-358, 2016

    The Japanese Society of Hematology

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