DIAGNOSIS AND TREATMENT OF INTESTINAL LYMPHOMA

Abstract

B-cell lymphomas, particularly diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL), are the most common intestinal lymphomas. The histological type can be distinguished based on the site and endoscopic findings. DLBCL is often found in the ileocecum and is frequently classified as ulcerative or polypoid. Considering the risk of perforation during chemotherapy, surgical treatment can be considered in patients with intestinal DLBCL. FL is usually detected endoscopically as multiple white nodules in the second portion of the duodenum, and the watch-and-wait approach is mostly adequate because of the indolent clinical course of the condition. Mucosa-associated lymphoid tissue (MALT) lymphoma often involves the rectum, and its treatment is diverse, including endoscopic resection. Immunoproliferative small-intestinal disease (IPSID) is a subtype of gastrointestinal MALT lymphoma. Mantle cell lymphoma (MCL) is typically found as multiple lymphomatous polyposis and is classified as a low-grade B-cell lymphoma, including FL and MALT lymphoma. It is important to distinguish MCL from both FL and MALT lymphomas because the aggressive clinical course of the former necessitates different management strategies. Intestinal T-cell lymphomas have been partially renamed in the latest WHO 5th edition. If there is a case of iatrogenic immunodeficiency, the possibility of an Epstein-Barr virus-positive mucocutaneous ulcer needs to be considered as a diagnosis, and the condition is characterized by spontaneous remission after immunosuppression reduction or discontinuation.