Zhang NS, Shi F, Kong L, Zhu H. Mucosa-associated lymphoid tissue lymphoma with unusual 18F-FDG hypermetabolism arising at the colorectal anastomosis. World J Gastroenterol 2017; 23(3): 551-559 [PMID: 28210093 DOI: 10.3748/wjg.v23.i3.551]
Corresponding Author of This Article
Hui Zhu, MD, PhD, Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan 250117, Shandong Province, China. drzhuhui@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 21, 2017; 23(3): 551-559 Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.551
Mucosa-associated lymphoid tissue lymphoma with unusual 18F-FDG hypermetabolism arising at the colorectal anastomosis
Na-Sha Zhang, Fang Shi, Li Kong, Hui Zhu
Na-Sha Zhang, Fang Shi, Li Kong, Hui Zhu, Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
Author contributions: Zhang NS contributed to the acquisition of case materials and drafting of the manuscript; Shi F collected the pictures and drafted the manuscript; Kong L performed critical revision of the manuscript; Zhu H performed critical revision of the manuscript and was the guarantor for this case report; all authors have read and approved the final manuscript.
Institutional review board statement: The case report was reviewed and approved by the Shandong Cancer Hospital affiliated to Shandong University Institutional Review Board, Jinan, China.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hui Zhu, MD, PhD, Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan 250117, Shandong Province, China. drzhuhui@163.com
Telephone: +86-531-67626112 Fax: +86-531-87984079
Received: September 17, 2016 Peer-review started: September 17, 2016 First decision: November 9, 2016 Revised: December 5, 2016 Accepted: December 16, 2016 Article in press: December 19, 2016 Published online: January 21, 2017 Processing time: 118 Days and 16.9 Hours
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates from the stomach and presents with low 18F-fluorodeoxyglucose (FDG) avidity with average maximum standard uptake value of 3.6. Colorectal MALT lymphoma is a rare entity that contributes to 1.6% of all MALT lymphomas and < 0.2% of large intestinal malignancies. The case reported herein firstly revealed stage IIE MALT lymphoma with unexpected higher 18F-FDG avidity of 18.9 arising at the colorectal anastomosis in a patient with a surgical history for sigmoid adenocarcinoma, which was strongly suspected as local recurrence before histopathological and immunohistochemical examinations. After accurate diagnosis, the patient received four cycles of standard R-CVP regimen (rituximab, cyclophosphamide, vincristine and prednisone), combined target therapy and chemotherapy, instead of radiotherapy recommended by National Comprehensive Cancer Network guidelines. He tolerated the treatment well and reached complete remission.
Core tip: This case highlighted the possibility of development of metachronous neoplasms at the colorectal anastomosis, especially rare mucosa-associated lymphoid tissue (MALT) lymphoma with unusual 18F-fluorodeoxyglucose (FDG) hypermetabolism. Chromosomal translocation leading to the activation of nuclear factor-κB pathway in proliferative B cells stimulated by pathogens may explain the etiopathogenesis for MALT lymphoma. Despite being indolent, MALT lymphoma can be successfully imaged by 18F-FDG-positron emission tomography (PET)/computed tomography (CT), and shows great 18F-FDG avidity. This indicates that PET/CT can be added to the workup of MALT lymphoma. Considering that MALT lymphoma originates from many organs, patient-tailored treatment including radiotherapy, chemotherapy and immunotherapy is necessary.
