Bone Marrow Biopsy

Focal involvement by small B-cell neoplasm without significant plasmacytic differentiation (CD3-, CD20+, PAX5+, kappa IHC-, lambda IHC-, CD5-, CD10-, BCL6-, BCL2+, cyclin D1-, IgD-, Ki67 low)

Courtesy of T Pongpruttipan, MD.

Review of Colonic Polyp Biospy Tissue

HE

CD20

HE HE

Courtesy of T Pongpruttipan, MD.

Final Pathological Diagnosis

Involvement by small B-cell lymphoid neoplasm with CD10+, BCL2+, BCL6- phenotype. No evidence of large cell involvement.

Some small and large cells showed large aggregates with infiltrative growth pattern.

IMP: follicular lymphoma with focus of large cell transformation

DDx DLBCL with accompanying follicular lymphoma Follicular lymphoma, grade 3/3 (focal) in the

background of follicular lymphoma, low grade

Colorectal Lymphoma

A type of extranodal lymphoma involving GI tract

Primary GI lymphoma Stomach 40-50% Small bowel 20-30% Colon and rectum

10-20%

Primary GI lymphoma No palpable, superficial LN No enlarged mediastinal LN

on CXR Normal WBC (No and

differential count) Only regional LN involved No involvement of liver and

spleen

Dawson IM, et al. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg 1961;49:80-9.

Staging of Lymphoma

Musshoff Modifications to Ann Arbor Staging System for Extranodal Lymphoma

Stage

I or IE Single lymphatic organ or extranodal site

II Two or more lymphatic regions on the same site of the diaphragm or a single extranodal organ and lymph node involvement at the same site of diaphragm

II1 Regional lymph node involved

II2 Distant lymph node involved

III Lymph node involved on both sides of diaphragm

IV Disseminated disease with involvement of bone marrow, liver, etc

Musshoff K. Strahlentherapie 1977;153:218-21.

Boot H. Best Pract Res Clin Gastroenterol 2010;24(1):3-12.

Common Types in Colorectal NHL

DLBCL 60% de novo Transformation from

CLL, follicular lymphoma, MALT

MALT 15%% Burkitt 15

Recent report from Terada T, Japan 37 cases of GI

lymphoma M:F 20:17 Median age 69 yr (46-

89) Types

Gastric 25 (68%) Small bowel 6 (16%) Colon 6 (16%)

Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012;2(3):194-200.

Gastrointestinal Lymphoma

Types B-cell 35 (95%) T-cell 2 (5%)

Gastric NHL 25 DLBCL 11 MALT 14

Small intestine DLBCL 4 PTCL 2

Colon 6 DLBCL 5 FL 1

Clinical diagnosis of colon NHL at first GIST 1 Colon carcinoma

4 Colon polyp 1

No cases of Hodgkin lymphoma Burkitt lymphoma Mantle cell lymphom

Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012;2(3):194-200.

Primary FL of GI tract:Massachusetts General Hospital, 1995-2010

Excluded cases History of FL outside

GI tract Widespread

lymphoma Distant nodal disease

within 6 months Multifocal diseases Splenic involvement FL in transformation

Misdraji J, et al. Primary follicular lymphoma of the

gastrointestinal tract. Am J Surg Pathol 2011;35:1255-63.

Presenting Symptoms/ Finding

Symptoms Abdominal pain and

nausea, vomiting (12), bowel obstruction

Intussuspection (1) Incidental finding (13)

on investigation of Reflux symptoms or

Barrett esophagus Screening for

colorectal cancer Resection of sigmoid

carcinoma

Macroscopic findings White patches or

plaques Mucosal nodularity or

granularity Nodules Polyp (1, 2, 3) Submucosal mass Thickening of wall or

folds

Misdraji J, et al. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol 2011;35:1255-63.