Duodenal-type follicular lymphoma

A 53-year-old woman underwent routine esophagogastroduodenoscopy and colonoscopy. She had no significant past medical history. The patient was asymptomatic. Physical examination and laboratory studies were unremarkable. Upper gastrointestinal endoscopy showed multiple small and whitish nodular lesions in the descending duodenum (Figure 1A). Capsule endoscopy did not find the same lesions in the jejunum and ileum. Colonoscopy revealed no abnormality. Histopathological examination revealed amounts of neoplastic follicles, which were composed uniformly of small cleaved cells in the lamina propria (Figure 1B). Immunohistochemical analysis confirmed positivity of the neoplastic cells for CD20 (Figure 1C), CD10 (Figure 1D), and BCL2 (Figure 1E), which were consistent with follicular lymphoma (FL). Extraintestinal involvement was excluded by bone marrow biopsy and whole-body positron emission tomography/computed tomography scanning. Finally, the patient received the diagnosis of duodenal-type follicular lymphoma (DFL) by the above findings. FL is defined as a neoplasm of germinal-center B cells usually with a follicular growth pattern. DFL is considered as a rare and newly recognized disease, which is a specific variant of FL. Given an excellent prognosis and infrequent progression for the rarely indolent non-Hodgkin lymphoma, the application of watch and wait strategy for her could be an appropriate and safe treatment option. ^, The patient chose to receive regularly endoscopic follow-up. Until now, she has remained asymptomatic with no signs of disease progression by endoscopy.