Abstract
A 70-year-old woman was examined with screening esophagogastroduodenoscopy. Endoscopic findings showed a reddish flat lesion with Ban unclear margin at the gastric angle and multiple white nodules in the 2nd part of the duodenum. Magnified endoscopy of thew gastric lesion with narrow band imaging showed a villous surface pattern and moderate microvascular atypia. The endoscopic diagnosis of the gastric lesion was MALT lymphoma, and that of the duodenal lesion was follicular lymphoma (FL). Biopsy specimens were taken from both lesions and pathological diagnosis was gastroduodenal FL. Double balloon endoscopy revealed multiple white nodules in the jejunum and ileum and thus this patient was diagnosed as having gastrointestinal follicular lymphoma. pirarubicin, cyclophosphamide, vincristine, prednisone and rituximab were chosen for the initial treatment. Gastric involvements of gastrointestinal FL have been reported in only 1.2% of FL cases. Multiple white nodules were observed in the duodenum, but not in the gastric lesion. Follicles in the stomach lesion existed in the deep mucosal layer compared with the duodenal lesion. Our opinion, therefore, was that the gastric lesion did not show the typical multiple white nodule pattern. We report a case of follicular lymphoma with stomach involvement.
