Malignant lymphoma is rarely encountered in health screening program. It is often difficult to recognize it at early stage although the earlier detection would bring the better prognosis like other malignancies.
Data of screening program with esophagogastroduodenoscopy (EGD) at Ota Memorial Hospital (OMH) in Japan from June 2012 through December 2017 were reviewed and cases of malignant lymphoma detected were analyzed to reveal characteristics.
26886 individuals participated in EGD screening program of OMH in that term. 91 cases of malignant neoplasm were detected and six of them (6.6%) were diagnoses as malignant lymphoma (detection rate 0.02%). They consisted of three gastric and three duodenal lymphomas. None of them had B symptom. Histopathological exam diagnosed all gastric cases as MALT lymphoma locating at middle part of stomach. Their endoscopic findings were as follows; one was scar-like whitish mucosa without stricture, another was whitish mucosa mixed with erythema, and the other was scar-like lesion surrounded nodular and granular mucosae. Although all gastric lymphoma had no eradication history of Helicobacter pylori (Hp) and serum anti-Hp IgG antibody were less than 3 U/ml, one of them had advanced chronic atrophic gastritis. All gastric MALT lymphoma took irradiation therapy. All duodenal lymphomas were diagnosed as follicular lymphoma. One of them located around duodenal papilla was recurrent lesion that had originated in mesenteric lymph nodes and been treated with chemotherapy six years before. Its endoscopic findings were polypoid and granular lesions. Other two duodenal lymphoma were detected at inferior duodenal angle as nodular and granular appearance. The recurrent follicular lymphoma had the second line chemotherapy. Other two cases were treated by irradiation and molecular targeting therapy with rituximab respectively.
Nearly 7% of malignancy detected by EGD screening program of OMH was malignant lymphoma consisting of gastric MALT lymphoma and duodenal follicular lymphoma although it was rarely encountered. Since it shows non-specific endoscopic findings especially at its early stage, mandate biopsy to any suspicious lesion is strongly recommended.
Clinical trial identification
Legal entity responsible for the study
Ota Memorial Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.