Korean J Gastroenterol.  2013 Aug;62(2):117-121. 10.4166/kjg.2013.62.2.117.

Primary Mucosa-associated Lymphoid Tissue Lymphoma of the Esophagus, Manifesting as a Submucosal Tumor

• Jung JG
• Kang HW
• Hahn SJ
• Choi JS
• Kim EJ

• KMID: 1775749
• DOI: http://doi.org/10.4166/kjg.2013.62.2.117

Abstract

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma in the esophagus that manifested as a large submucosal tumor (SMT). Primary esophageal lymphoma is very rare, occurring in less than 1% of all patients with gastrointestinal lymphoma. Only a few cases of MALT lymphoma in the esophagus have been reported in the English literature. A 53-year-old man was referred to Dongguk University Ilsan Hospital (Goyang, Korea) in July 2012 for further evaluation and treatment of an esophageal SMT. Endoscopy showed a cylindrically elongated submucosal mass with normal overlying mucosa in the mid esophagus, 25-30 cm from the incisor teeth. He underwent surgery to confirm the diagnosis. Pathologic findings showed diffuse small atypical lymphoid cells which were stained with Bcl-2, CD20, but not with CD3, CD5, CD23, Bcl-6, or cyclin D1. These cells showed a positive monoclonal band for immunoglobulin heavy chain gene rearrangement. Based on the pathological, immunohistochemical, and molecular biological features, the esophageal mass was diagnosed as extranodal marginal zone B-cell lymphoma of the MALT type.

Keyword

Esophagus; Lymphoma; B-Lymphocytes; Marginal zone B-cell lymphoma

MeSH Terms

Antigens, CD20/metabolism
Bone Marrow/pathology
Esophageal Neoplasms/*diagnosis/pathology/surgery
Gastroscopy
Humans
Immunohistochemistry
Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology/surgery
Male
Middle Aged
Mucous Membrane/pathology
Proto-Oncogene Proteins c-bcl-2/metabolism
Tomography, X-Ray Computed
Antigens, CD20
Proto-Oncogene Proteins c-bcl-2

Figure

• 

  Fig. 1. Endoscopic findings. (A) Endoscopic observation shows a cylindrically elongated submucosal mass in the mid esophagus (25–30 cm from the incisor teeth). (B) Endoscopic ultrasonography shows an ovoid homogenous hypoechoic mass (arrow) originating from the third hyperechoic layer (submucosa).

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  Fig. 2. Chest computed tomography findings. (A) There is a mediastinal solid mass arising from the esophagus wall (arrow). Its density is homogenous. (B) Sagittal reconstruction view shows a well-circumscribed longitudinal mass, following the path of the esophagus (arrow). There is a posterior displacement of the esophageal lumen by the mass.

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  Fig. 3. Pathologic features. (A) Diffuse infiltration of atypical lymphoid cells occupying the marginal zone of the lymphoid follicle (H&E; left, ×12.5; right, ×100). (B) Positive immunoreactivity for the bcl-2 protein (immunohistochemistry, ×200). (C) Positive immunoreactivity for the CD20 protein (immunohistochemistry, ×200).

Reference

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