Résumé
A 74-year old male was admitted to St. Mary's Hospital due to symptoms of diarrhea and fever. He was diagnosed with MALToma in the jejunum 6 months previously, but had refused any treatment. This time, an endoscopy revealed multiple erosions and nodular mucosa in the body, fundus of the stomach and 3rd portion of duodenum. Abdominal computed tomography showed wall thickening in 3rd portion of the duodenum and upper jejunum with multiple lymph nodes enlargement. Additionally, an endoscopic biopsy revealed MALToma in the stomach and duodenum. Salmonella group B grew in a blood culture and a chest PA determined pneumonic infiltration in the left lower lobe. He received sulperazone for 7 days, but again refused any further treatment and was thereby discharged after had improved condition.
Sujets)
Sujet âgé , Humains , Mâle , Biopsie , Diarrhée , Duodénum , Endoscopie , Fièvre , Intestin grêle , Jéjunum , Noeuds lymphatiques , Lymphome B de la zone marginale , Muqueuse , Salmonella , Estomac , ThoraxRésumé
Mucosa-associated lymphoid tissue (MALT) lymphoma is the disease of distinctive clinicopathologic entities most of which are different from current lymph-node based lymphoma classification. According to the circulatory properties of the lymphocytes and specific immunoglobulin isotype distribution, MALT is defined as the central lymphoid tissue and is opposed to peripheral somatic lymphoid tissue. It occurs most often in the gastrointestinal mucosa and the bronchial mucosa and may occur in other organs such as salivary gland, thyroid gland, conjunctiva, skin. The most common site of MALT lymphoma is gastrointestinal tract but non-gastrointestinal MALT lymphoma may present. The characteristics of pathology are reactive follicles surrounded by the diffuse infiltration of centrocyte-like (CCL) cells and lymphoepithelial lesion due to the gland invasion of CCL cells. It is a localized disease and has a long survival, Isaacson et al suggested the classification of primary gastrointestinal MALT lymphoma as low grade, high grade, immunoproliferative small intestinal disease (IPSID). The distribution is more often in the stomach than in the intestine. Intestinal MALT lymphomas have less favorable clinicnl courses than the gastric MALT lymphomas. Recurrences may appear in the same organ or in other extranodal sites. We report clinical, pathologic findings, and clinical course in a case of primary small intestinal MALT lymphoma in terminal ileum with literature review.