Ileal Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma with a Large-Cell Component That Regressed spontaneously

Abstract

Reported herein is a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the terminal ileum with a large-cell component, which regressed spontaneously. To the best of our knowledge, only five cases of spontaneously regressing MALT lymphoma have been reported in the English-language literature, and all of these cases were low-grade lymphomas. Spontaneous regression of a MALT lymphoma with a high-grade component is very rare. The present case suggests that MALT lymphoma cells have a reversible nature, even in the presence of a high-grade component.

Case Details

Disease Location

Ileum mucosa

Personal Characteristics

38 -year-old male january 2007

Clinical Characteristics

Original visit to hospital was due to complain of epigastralgia after meals, physical exam revealed no abnormalities lab work consisted of blood count (wbc 7,300/microliter), serum c-reacive protein (3.0 mg/dl), hemoglobin (16 g/dl), serum level of soluble IL-2 receptor (285 u/ml), serum test for antibody against helicobacter pylori was negative, serum test for antibody against yersinia enterocolitica was negative no significant growth found from the stool culture; serum levels of IGG, IGM, and IGA were in normal limits a small bowel series found a radiolucent area with an irregular border measuring 7-10mm in diameter in the terminal ileum. CT revealed slightly enlarged ileocecal lymph nodes colonoscopic exam found multiple protruding lesions in the terminal ileum with erosive tops covered by edematous mucosa. The lesion was about 10 mm in diameter hematoxylin-eosin staining of biopsy specimens revealed dense homogenous plasmacytoid cell infiltration to the epithelium, which is different from the normal lymphatic tissue. Histological sections also showed lymphoepithelial lesions characterized by infiltration of lymphoma cells to the epithelium immunohistochemical staining revealed that the majority of the cells were positive for CD20 in addition to the typical mucosa-associated lymphoid tissue (malt) cells, there was also a small area of different cell aggregates with solid or sheet-like proliferation of transformed cells. These cells had swollen, light-colored nuclei and a high nuclear-cytoplasmic ratio, resembling the cells of diffuse large b-cell lymphoma. Most cells were positive for mib-1 staining, implying high proliferation and were negative for CD10 and bcl-2 chest, abdominal and pelvis CT, head MRI, PET, upper gi endoscopy, and bone marrow aspiration revealed no other lesions other than at the terminal ileum. Rapid urease test and microscopic exam of the specimens confirmed absence of h. Pylori infection. No malt lesions were detected in orbita, thyroid and salivary glands diagnosis of primary malt lymphoma or the terminal ileum with high grade transformation with the presence of the clbcl-like component. Surgery and chemo was planned for in march 2007

Remission Characteristics

Upon arrival for surgery, CT couldn't detect any enlarge ileocecal lymph nodes nor the lesion in the ileum during a pre-op colonoscopic exam biopsy specimens revealed mild inflammation with lymphoid cell infiltration and no lesion compatible to malt lymphoma a small bowel series failed to reveal any pathological regions, thus surgery was given up and follow-up endoscopy was determined tumor disappeared in 2 months 24 months since initial detecting, no evidence of recurrence through colonoscopic studies (i'm guessing this was a complete remission, although isn't stated)

Treatment & Mechanisms

Proposed Remission Mechanisms

The malt lymphoma may have developed due to some infection and the lymphoma resolved after the infection resolved (reason for the wbc count, serum crp, and inflammation)

Clinical Treatment

None reported

Non-Clinical Treatment

None reported