Clin Endosc.  2021 Sep;54(5):759-762. 10.5946/ce.2020.233.

Successful Endoscopic Resection of Residual Colonic Mucosa-Associated Lymphoid Tissue Lymphoma after Polypectomy

• Choi J

• KMID: 2520561
• DOI: http://doi.org/10.5946/ce.2020.233

Abstract

Mucosa-associated lymphoid tissue (MALT) lymphomas are typically found in the stomach, while colonic MALT lymphoma is rarely found. Considering its rarity, definitive treatment of colonic MALT lymphoma has not been established. Different from that in the stomach, Helicobacter pylori infection might play a minor role while determining the treatment of colonic MALT lymphoma. If colonic MALT lymphoma is localized, treatment options are surgical resection, radiation, endoscopic resection, or combination therapy. Here, we report a case of residual colonic MALT lymphoma after endoscopic mucosal resection, which was a 1.5-cm-sized tumor confined to the superficial wall of the rectum. The lesion was successfully treated using the endoscopic submucosal dissection technique. The patient remained disease-free for 4 years. This case provides rationale for endoscopic submucosal dissection treatment as a salvage therapy for residual tumors in properly selected patients with colonic MALT lymphoma.

Keyword

Colon; Endoscopic mucosal resection, Endoscopic submucosal dissection; Marginal zone B-cell lymphoma

Figure

• 

  Fig. 1. Endoscopic submucosal dissection for mucosa-associated lymphoid tissue lymphoma. (A) Colonoscopy revealed a 1.5-cm residual nodular sessile tumor with scar tissue. Multiple red spots and capillaries were noted on the tumor surface. (B) Normal saline mixed with indigo carmine was injected into the submucosal layer. (C) Circumferential mucosal incision and submucosal dissection were performed with a Dual knife. (D) Complete submucosal dissection was performed. (E) En bloc resected tumor. (F) At the 1-year follow-up, colonoscopy revealed a white scar without recurrence.

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  Fig. 2. Pathologic findings. (A) Diffuse dense infiltration of atypical small lymphocytes (hematoxylin and eosin [H&E] stain, ×100). (B) Polymorphous lymphoid infiltrates including small lymphocytes, centroblast-like cells, and centrocyte-like cells were observed (H&E stain, ×400). (C, D) These lymphocytes immunohistochemically showed diffusely positive staining for CD20 (C) and negative staining for CD3 (D).

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