Kendal YALÇIN, Zuhat URAKÇI, Mustafa YAKUT, Nihal KILINÇ

Sistemik kemoterapi sonrası uzun dönemli remisyonla seyreden intestinal MALT lenfoma: Olgu sunumu

MALT lenfoma çeşitli organlarda ortaya çıkan ekstranodal lenfomanın bir türüdür. MALT lenfoma özellikle düşük grade olanlar cerrahi rezeksiyon, radyoterapi ve kemoterapi sonrası sıklıkla nüks etme eğilimindedir. Bu olgu sunumunda sistemik kemoterapi sonrası uzun dönemli remisyonla seyreden intestinal MALT lenfoma olgusu sunulmuştur. 27 yaşında erkek hasta kliniğimize karın ağrısı, kilo kaybı ve ateş şikayetleri ile başvurdu. Yapılan fizik muayenesinde batında tüm kadranlarda hassasiyeti mevcuttu. Endoskopik incelemede ise duodenumda nodüler görünüm mevcuttu. Batın tomografisinde sol hipokondriumda barsak duvar kalınlaşması mevcuttu ve çok sayıda mezenterik lenfadenopatisi vardı. Duodenum biyopsisinde lamina propriayı infiltre eden sentrosit benzeri hücreler mevcuttu. B hücre yüzey belirteçlerinden CD20 pozitif saptandı. Helikobakter pylori negatifti. Hastaya düşük dereceli MALT lenfoma tanısı konuldu. 6 kür CHOP kemoterapisi sonrası 4. yılda hastada klinik, endoskopik, histolojik ve radyolojik remisyon hali mevcuttu. Sonuç olarak düşük grade MALT lenfomada lokalize hastalıkta ilk tedavi seçeneği cerrahi olmasına rağmen sadece CHOP kemoterapisi ile bazı vakalarda uzun süreli remisyon sağlamak mümkün olabilir.

Anahtar Kelimeler:

Malt lenfoma, duodenum, kemoterapi

Intestinal MALT lymphoma with long-term remission after systemic chemotherapy: A case report

Mucosa-associated lymphoid tissue lymphoma, as a type of extranodal lymphoma, originates in various organs. Low-grade mucosa-associated lymphoid tissue lymphomas often tend to recur after surgical resection, radiotherapy and chemotherapy. Here, we report a case of intestinal mucosa-associated lymphoid tissue lymphoma with long-term remission after systemic chemotherapy. A 27-year-old male patient admitted to our clinic due to symptoms of abdominal pain, weight loss and fever. Physical examination revealed diffuse tenderness throughout the abdomen. Gastroduodenoscopy revealed nodular lesions in the duodenum. There was a thickened bowel wall in the left hypochondrium with several mesenteric lymphadenopathies on the abdominal tomography. Duodenal biopsy was composed of centrocyte-like cells, with infiltration of the lamina propria, and was positive for B cell surface markers, including CD20. Helicobacter pylori was found to be negative. The diagnosis of low-grade mucosa-associated lymphoid tissue lymphoma was made. The patient has had sustained clinical, endoscopic, histological, and radiological remission for four years after six courses of cyclophosphamide, vincristine, doxorubicin and prednisone chemotherapy. In conclusion, although surgery is the first-line therapy in localized low-grade mucosa-associated lymphoid tissue lymphoma, it may be possible to induce long-term remission with cyclophoshamide, vincristine, doxorubicin and prednisone chemotherapy alone.

Keywords:

Malt lymphoma, duodenum, chemotherapy,

PDF

___

Koniaris LG, Drugas G, Katzman PJ, et al. Management of gastro- intestinal lymphoma. J Am Coll Surg 2003;197:127–41.
Isaacson P, Wright DH. Malignant lymphoma of mucosa-associa- ted lymphoid tissue: A distinctive type of B-cell lymphoma. Cancer 1983;52:1410-6.
Radaszkiewiez T, Dragosics B, Bauer P. Gastrointestinal malignant lymphoma of the mucosa-associated lymphoid tissue: Factors rele- vant to prognosis. Gastroenterology 1992;102:1628-38.
Zinzani PL, Magagnoli M, Galieni P, et al. Nongastrointestinal low- grade mucosa-associated lymphoid tissue lymphoma: Analysis of 75 Patients. J Clin Oncol 1999;17:1254-8.
Toshima M, Aikawa K, Soga K, et al. Primary Duodenal MALT lymphoma. Internal Medicine 1999;38:957- 61.
Roggero Eİ, Zucca E, Pinotti G. Eradication of Helicobacter pylori infection in primary low-grade gastric lymphoma of mucosa-asso- ciated lymphoid tissue. Ann Intern Med 1995;122:767-9.
Sarkhosh K, Bathe OF, Stewart DA, et al. The role of surgical inter- vention in the management of duodenal lymphoma. J Surg Oncol 2009;99:428–32.
lsaacson PG. MALT lymphoma concept updated. Ann Oncol 1995;6:319-20.
Yaşa MH, Bektaş A, Örmeci N. [Primary gastric lymphomas]. An- kara Üniversitesi Tıp Fakültesi Mecmuası. 1996;49:243-50.
Tadmor T, Rainis T, Bejar J, et al. Primary duodenal mucosa-asso- ciated lymphoid tissue (MALT) lymphoma – A rare presentation of gastric outlet obstruction. Can J Gastroenterol 2007;21:393-5.
Nagashima R, Takeda H, Maeda K, et al. Regression of duodenal mucosa-associated lymphoid tissue lymphoma after eradication of Helicobacter pylori. Gastroenterology 1996;111:1674-8.
Kim JS, Jung HC, Shin KH, et al. Eradication of Helicobacter pylori infection did not lead to cure of duodenal mucosa-associated lymphoid tissue lymphoma. Scand J Gastroenterol 1999;34:215- 18.
Ochi M, Tominaga K, Okazaki H, et al. Regression of primary low- grade mucosa-associated lymphoid tissue lymphoma of duodenum after long-term treatment with clarithromycin. Scand J Gastroen- terol 2006;41:365-9.
Zelenetz AD, Advani RH, Buadi F, et al. Non-Hodgkin’s lymphoma. J Natl Compr Care Netw 2006;4:258–310.
Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non- Hodgkin’s lymphoma: I. Anatomic and histologic distribution, clini- cal features, and survival data of 371 patients registered in the German multicenter study GIT NHL 01/92. J Clin Oncol 2001;19:3861–73.
Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non- Hodgkin’s lymphoma: II. Combined surgical and conservative or conservative management only in localized gastric lymphoma—Re- sults of the prospective German multicenter study GIT NHL 01/92. J Clin Oncol 2001;19:3874–83.
Lepicard A, Lamarque D, Levy M, et al. Duodenal mucosa-associa- ted lymphoid tissue lymphoma: Treatment with oral cyclophospha- mide. Am J Gastroenterol 2000;95:536-9.
Ventrucci M, Gherlinzoni F, Sabattini E, et al. Primary MALT- lymphoma of the papilla of Vater. Dig Dis Sci 1998;43:214-6.
Doğan A, Cansöz Ö. [Diagnostic and prognostic characteristics of MALT type extranodal lymphomas]. Turkiye Klinikleri J Int Med Sci 2005;1:44-8.