A case of follicular lymphoma in the duodenum successfully treated with surgical resection after eradication of Helicobacter pylori

Abstract

A 69-year-old man who had undergone pylorus-preserving gastrectomy for early gastric cancer 7 years before was diagnosed as a B cell lymphoma (small cell type) in the duodenum by annual endoscopic examination with biopsy. The lesion was located at the anterior wall in the descending part of the duodenum, and its size was 1cm in diameter. It was considered to be a MALToma with positive for Helicobacter pylori (H.p.) infection and eradication of H.p. was performed. Four months later, the endoscopic examination revealed no apparent effect after the successful eradication. Furthermore, cytogenetic examination showed abnormality of t (14 ; 18) . Therefore, this case was suspected as follicular lymphoma. Under the clinical diagnosis of the stage I case of duodenal lymphoma without response to H.p. eradication, local resection was successfully performed and the post operative course was uneventful. The histopathological diagnosis was follicular lymphoma decisively, the surgical margin was free from lymphoma and resected regional lymph nodes were not involved. When curative resection without difficulty is predicted and least defect of post operative quality of the patient's life is expected, surgical treatment might be worth the second line of treatment after the erradication therapy for H.p.