A case of primary follicular lymphoma of the duodenum

Abstract

We report a case of primary follicular lymphoma of the duodenum with an unusual macroscopic lesion. A 62-year-old-woman admitted for epigastric pain had undergone direct hemostasis for a hemorrhagic duodenal ulcer 7 years earlier, and had been followed up regularly. Upper gastroendoscopic examination upon admission showed multiple elevated lesions covered with slightly whitish mucosa at the ampulla of Vater and, on the anal side, thickened folds with a waffle-like appearance. Biopsy indicated follicular lymphoma. Because no findings suggested other organ or mediastinum/celiac lymph node metastasis, we believed the duodenum to be the primary organ. After subtotal stomach-preserving pancreaticoduodenectomy, histopathological analysis showed lymph nodes 13 and 17 to be positive. The disease stage was II1E based on the Ann Arbor system and Bunder Naqvi classification. Because of curative resection and the early stage, she did not undergo chemotherapy or other postoperative treatment and after 7 months of follow-up shows no evidence of recurrence. ©2007 The Japanese Society of Gastroenterological Surgery.