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


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