J Korean Med Sci.  2011 May;26(5):686-689. 10.3346/jkms.2011.26.5.686.

Marginal Zone B-cell Lymphoma of MALT in Small Intestine Associated with Amyloidosis: A Rare Association

• Park S
• Cho HY
• Ha SY
• Chung DH
• Kim NR
• An JS

• KMID: 1777871
• DOI: http://doi.org/10.3346/jkms.2011.26.5.686

Abstract

A 62-yr-old man presented with a 5-yr history of intermittent abdominal distention and pain. These symptoms persisted for several months and subsided without treatment. A diagnosis of suspected small bowel lymphoma was made based on plain radiograph and computerized tomogram findings, and he was referred to our institution for further evaluation. Segmental resection of the small intestine was performed and the diagnosis of marginal zone B-cell lymphoma associated with amyloidosis was made. This is the first case of marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) in the small intestine associated with amyloidosis in Korea.

Keyword

Gastrointestinal Tract; Lymphoma; Lymphoma, B-Cell, Marginal Zone; Amyloidosis

MeSH Terms

Abdominal Pain
Amyloidosis/complications/*pathology
Biopsy
Diagnosis, Differential
Endoscopy
Humans
Inflammatory Bowel Diseases/diagnosis
Intestine, Small/*pathology
Lymphoma, B-Cell, Marginal Zone/complications/*pathology
Male
Middle Aged

Figure

• 

  Fig. 1 Histologic features of a resection specimen of small intestine. (A) The intestinal wall was thickened by a double process. Here, amorphous acidophilic material in the submucosa and intestinal wall were mixed with lymphoid infiltrate (H&E, scanning view). (B) High power view (H&E, × 40) and apple-green bi-refringence under polarized light is seen Congo-red staining of amyloid (inset). (C) Diffuse proliferative lymphoid infiltrate through the intestinal wall up to the serosa (H&E, scanning view). (D) The lymphoid infiltrate was composed mainly of small lymphoid cells (H&E, × 400).

• 

  Fig. 2 Histologic features of mesenteric lymph node biopsy. Amyloid deposits are dense admixed with some aggregates of lymphoid cells. Islands of lymphoid infiltration are composed of small lymphoid cells, some of which show plasmacytic differentiation (H&E, scanning view and × 100-inset).

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  Fig. 3 The immunohistochemical findings. The lymphoid infiltrate was positive for CD20, (A) Ki-67 labeling index was low (less than 5%), (B) kappa light chain-producing plasma cells were detected, (C) with the exclusion of lambda light chain-producing plasma cells, (D) (immunoperoxidase, × 400).

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