Follicular and mantle cell lymphoma diagnosed in biopsies of gastroenterocolic region
Authors:
Lukáš Plank 1,2; Tomáš Balhárek 1,2; Peter Szépe 1,2
Authors‘ workplace:
Konzultačné centrum bioptickej diagnostiky ochorení krvotvorby v SR
Ústav patologickej anatómie Jesseniovej lekárskej fakulty Univerzity Komenského a Univerzitnej nemocnice v Martine
1; Konzultačné centrum bioptickej diagnostiky ochorení krvotvorby v SR
Martinské bioptické centrum, s. r. o. v Martine
2
Published in:
Čes.-slov. Patol., 52, 2016, No. 1, p. 31-39
Category:
Original Article
Overview
The authors present a retrospective analysis of follicular lymphomas (FL) and mantle cell lymphomas (MCL) diagnosed according to the WHO classification (2008) in consecutive biopsies of GI organs in a period of 11 years. The series includes 18 patients with FL verified in 22 biopsies and 44 patients with MCL diagnosed in 54 biopsies. FL represented always a solitary tumor, most often – up to ¾ of all the cases – of a small intestine, more often in its jejunoileal than duodenal parts. The biopsies were obtained almost equally by endoscopical approach, they were usually mucosal and rarely polypectomic, as well as by surgical resections (54,5 % and 45,5 % of the cases respectively). FL of grade 3 was identified in approximately 11 % of the cases, while majority of the patients showed FL of grade 1 or 2. Only 2 patients with duodenal FL relapsed and bioptically verified recidives did not show signs of a high grade transformation. Although it was difficult to identify a nodular growth pattern in more common small biopsies, a typical histomorphology and phenotype mostly allowed the FL diagnosis in the majority of the cases. The FL diagnosis had to be supported by detection of BCL2 translocation only in one case. MCL appeared most often in the stomach and large intestine, the small intestinal cases represented less than 23 %. In ¼ of the patients the lymphoma was multifocal and manifested as lymphomatoid polyposis affecting most often both large and small intestine. In a majority of the MCL patients, the diagnosis was done in mucosal and polypectomic endoscopic biopsies, surgical intervention and resection was recorded in less than 10 % of the cases. Most of the patients showed conventional „centrocytic“ MCL morphology and approximately ¼ of the cases showed blastoid MCL. The rebiopsies of 9 patients revealed a relaps of the disease which was locoidentical in 5 of them; in other 4 patients the biopsies documented a dissemination to other GI organs. The blastic transformation was recognized only in one of the relapsing patients. In contrast to FL, in 18 % of the biopsies the MCL diagnosis required a CCND1 gene rearrangement detection by FISH. In summary both of the studied GI lymphomas showed different and heterogenous incidence, clinical manifestation and necessity to support the biopsy diagnosis also by FISH examination. The correct FL and MCL diagnosis represents a conditio sine qua non for an indication of different therapeutical modalities as well as for the prognostic stratification of the patients.
Keywords:
extranodal non-Hodgkin lymphoma – gastrointestinal tract – follicular lymphoma – mantle cell lymphoma – marginal zone B-cell lymphoma of MALT-type – reactive lymphoid follicular hyperplasia
Sources
1. Shia J, Teruya-Feldstein J, Pan D, et al. Primary follicular lymphoma of the gastrointestinal tract: s clinical and pathologic ptudy of 26 cases. Am J Surg Pathol 2002; 26(2): 216-224.
2. Swerdlow SH, Campo E, Harris, NL, et al. WHO classification of tumours of heamatopoietic and lymphoid tissues (4th ed). Lyon: IARC; 2008, 439 s.
3. Burke JS. Lymphoproliferative disorders of the gastrointestinal tract. A review and pragmatic guide to diagnosis. Arch Pathol Lab Med 2011; 135(10): 1283–1297.
4. Salar A, Juanpere N, Bellosillo B, et al. Gastrointestinal involvement in mantle cell lymphoma: a prospective clinic, endoscopic, and pathologic study. Am J Surg Pathol 2006; 30(10): 1274-1280.
5. Jain VK, Bystricky B, Wotherspoon AC, Chau I, Cunningham D. Primary follicular lymphoma of the GI Tract: sn increasingly recognized entity. J Clin Oncol 2012; 30(36): e370-e372.
6. Bennani-Baiti N, Daw HA, Cotta C, et al. Low-grade follicular lymphoma of the small intestine: a challenge for management. Semin Oncol 2011; 6(38): 714–720.
7. Damaj G, Verkarre V, Delmer A, et al. Primary follicular lymphoma of the gastrointestinal tract: a study of 25 cases and a literature review. Ann Oncol 2003; 14(4): 623–629.
8. McNamara C, J Davies J, Dyer M, et al. Guidelines on the investigation and management of follicular lymphoma. Br J Hematol 2011; 156(4): 446–467.
9. Misdraji J, Harris NL, Hasserjian RP, Lauwers GY, Ferry JA. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol 2011; 35(9): 1255-1263.
10. Rosenwald A, Wright G, Wiestner A, et al. The proliferation gene expression signature is a quantitative integrator of oncogenic events that predicts survival in mantle cell lymphoma. Cancer Cell 2003; 3(2): 185-197.
11. Ruskoné-Fourmestraux A, Audouin J. Primary gastrointestinal tract mantle cell lymphoma as multiple lymphomatous polyposis. Best Pract Res Clin Gastroenterol 2010; 24(1): 35-42.
12. Krauss E, Konturek P, Maiss J, et al. Clinical significance of lymphoid hyperplasia of the lower gastrointestinal tract. Endoscopy 2010; 42(4): 334-337.
13. Albuquerque A. Nodular lymphoid hyperplasia in the gastrointestinal tract in adult patients: A review. World J Gastroint Endoscopy 2014; 6(11): 534-540.
14. Kella VKN, Constantine R, Parikh NS, et al. Mantle cell lymphoma of the gastrointestinal tract presenting with multiple intussusceptions -- case report and review of literature. Word J Surg Oncol 2009; 7: 60-66.
15. Michopoulos S., Petraki, K., Matsouka Ch, Kastritis E, Chrysanthopoulou H, Dimopoulos MA. Mantle-cell lymphoma (Multiple lymphomatous polyposis) of the entire GI tract. J Clin Oncol 2008; 26(9): 1555-1557.
16. Kim JH, Jung HW, Kang KJ et al. Endoscopic findings in mantle cell lymphoma with gastrointestinal tract involvement. Acta Haematol 2012; 127(3): 129–134.
17. Jares P, Colomer D, Campo E. Molecular pathogenesis of mantle cell lymphoma. J Clin Invest 2012; 122(10): 3416-3423.
18. Campo E, Rule S. Mantle cell lymphoma: evolving managment strategies. Blood 2015; 125 (1): 48-55.
19. Dreyling M, Geisler C, Hermine O, et al. Newly diagnosed and relapsed mantle cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25(Suppl 3): 83-92.
20. Kerrigan DP, Foucar K, Dressler L. High-grade non-Hodgkin lymphoma relapsing as lowgrade follicular lymphoma: so-called downgraded lymphoma. Am J Hematol 1989; 30(1): 36-41.
21. Plank L. Význam detekcie cyklínu D1 (a CD5) v diagnostike malígnych lymfómov iných než je lymfóm z pláštových buniek. Cesk Patol 2011; 47(3): 96-100.
22. McKay P, Leach M, Jackson R, Cook G, Rule S; British Committee for Standards in Haematology. Guidelines for the investigation and management of mantle cell lymphoma. Br J Haematol 2012; 159(4): 405-426.
Labels
Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
2016 Issue 1
Most read in this issue
- Serrated adenomas and carcinomas of the colon
- Morphology of the gastroesophageal reflux disease
- Follicular and mantle cell lymphoma diagnosed in biopsies of gastroenterocolic region
- Postinfectious glomerulonephritis in adults: a hidden face of an old disease