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. 2018 Jul;16(1):741-748.
doi: 10.3892/ol.2018.8744. Epub 2018 May 18.

Gastric Follicular Lymphoma: A Report of 3 Cases and a Review of the Literature

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Free PMC article

Gastric Follicular Lymphoma: A Report of 3 Cases and a Review of the Literature

Hee Young Na et al. Oncol Lett. .
Free PMC article

Abstract

Follicular lymphoma (FL) occurs primarily in the gastrointestinal tract, with the stomach being one of the rarest sites. According to the literature, <20 cases of primary gastric FL have been reported, with the number of cases with detailed pathological descriptions being even less. The aim of the present study was to compare clinicopathological features of gastric FL with FL at alternative sites. A total of 3 cases of gastric FL were retrieved from among 3,216 cases in the databases of 4 university hospitals in South Korea: Seoul National University (SNU) Hospital, SNU Boramae Hospital, SNU Bundang Hospital (all Seoul, South Korea) and Dongtan Sacred Heart Hospital Hallym University (Dongtan, South Korea), including 2 primary cases and 1 case that was possibly secondary to nodal FL. The 2 primary gastric FL cases were incidentally detected in routine health check-ups. An endoscopy revealed a single polypoid submucosal mass and biopsies failed to confirm the diagnosis due to minimal mucosal involvement. Therefore, a partial gastrectomy was performed. The epicenters of the tumors were submucosal, with focal extension to the muscularis propria. However, 1 case exhibited an isolated FL nodule in the omentum. Histopathological examination revealed FL of grade 1-2 with a follicular pattern and with strong expression of germinal center markers and B-cell lymphoma 2 (BCL2). Rearrangement of BCL2 was not identified using fluorescence in situ hybridization studies in 2 cases. In contrast to these 2 cases, the remaining FL case was confirmed with an endoscopic biopsy. The endoscopy revealed multiple eroded polypoid lesions, and pathology revealed FL of grade 1-2 with a predominantly diffuse pattern, and with immunoglobulin heavy chain IGH/BCL2 translocation. In view of the extensive lymphadenopathy, the last case possibly presented as secondary involvement of nodal FL. It is challenging to diagnose FL in the stomach due to little mucosal involvement, as well as the unfamiliarity of the tumor due to its rarity. However, the results of the present study suggest that primary gastric FL may exhibit unique pathological features, including a predominantly follicular pattern and an absence of BCL2 rearrangement.

Keywords: B-cell lymphoma 2; follicular lymphoma; gastric lymphoma.

Figures

Figure 1.
Figure 1.
Representative features of case 1, primary gastric follicular lymphoma. (A) An endoscopy and (B) the resected specimen revealed a well demarcated polypoid mass in the gastric body. Microscopically, nodular aggregates of small lymphoid cells in the submucosa with little mucosal involvement are characteristic, as demonstrated by hematoxylin and eosin staining at (C) ×10 and (D) magnification, ×40. (E) Tumor cells were positive for CD10 (magnification, ×40). (F) The follicular dendritic cell network was preserved, using anti-CD21 (magnification, ×40). The omental nodule revealed similar results following (G) hematoxylin and eosin and (H) anti-CD10 staining (magnification, ×40). CD, cluster of differentiation.
Figure 2.
Figure 2.
Representative features of case 2, primary gastric follicular lymphoma. Microscopic results identified follicular lymphoma centered in the submucosa at (A) ×10 and (B) ×40 magnification using hematoxylin and eosin staining. (C) No follicular dendritic cells were identified using anti-cluster of differentiation 21 (magnification, ×40). (D) Tumor cells expressed BCL2 protein (magnification, ×400), however, (E) the majority of tumor cells exhibited two, split, red and green signals in fluorescence in situ hybridization using a dual fusion probe. BCL2, B-cell lymphoma 2.
Figure 3.
Figure 3.
Case 3 was suspected to be a secondary involvement of nodal follicular lymphoma. (A) An endoscopy revealed multiple protruded lesions with erosions. Microscopically, tumor cells diffusely infiltrated the mucosa, without lymphoepithelial lesions, as stained by hematoxylin and eosin and imaged at (B) ×200, and (C) ×400 magnification. Tumor cells were positive for (D) cluster of differentiation 10 and (E) BCL6 (magnification, ×400). (F) immunoglobulin heavy locus/BCL2 translocation was revealed by fluorescence in situ hybridization study using a dual fusion probe. BCL2, B-cell lymphoma 2.

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