Bone Marrow Biopsy n Focal involvement by small

Bone Marrow Biopsy n Focal involvement by small B-cell neoplasm without significant plasmacytic differentiation (CD 3 -, CD 20+, PAX 5+, kappa IHC-, lambda IHC-, CD 5 -, CD 10 -, BCL 6 -, BCL 2+, cyclin D 1 -, Ig. D-, Ki 67 low) Courtesy of T Pongpruttipan, MD.

Review of Colonic Polyp Biospy Tissue CD 20 Courtesy of T Pongpruttipan, MD. HE HE HE

Final Pathological Diagnosis n Involvement by small B-cell lymphoid neoplasm with CD 10+, BCL 2+, BCL 6 - phenotype. No evidence of large cell involvement. n Some small and large cells showed large aggregates with infiltrative growth pattern. n IMP: follicular lymphoma with focus of large cell transformation n DDx DLBCL with accompanying follicular lymphoma n Follicular lymphoma, grade 3/3 (focal) in the background of follicular lymphoma, low grade n

Colorectal Lymphoma n A type of extranodal n Primary GI lymphoma involving n No palpable, superficial LN GI tract n No enlarged mediastinal LN on CXR n Primary GI lymphoma n Normal WBC (No and n Stomach 40 -50% differential count) n Small bowel 20 -30% n Only regional LN involved n Colon and rectum 10 n No involvement of liver and 20% spleen Dawson IM, et al. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg 1961; 49: 80 -9.

Staging of Lymphoma

Musshoff Modifications to Ann Arbor Staging System for Extranodal Lymphoma Stage I or IE Single lymphatic organ or extranodal site II Two or more lymphatic regions on the same site of the diaphragm or a single extranodal organ and lymph node involvement at the same site of diaphragm II 1 Regional lymph node involved II 2 Distant lymph node involved III Lymph node involved on both sides of diaphragm IV Disseminated disease with involvement of bone marrow, liver, etc Musshoff K. Strahlentherapie 1977; 153: 218 -21. Boot H. Best Pract Res Clin Gastroenterol 2010; 24(1): 3 -12.

Common Types in Colorectal NHL n DLBCL 60% n de novo n Transformation from CLL, follicular lymphoma, MALT n Burkitt 15%% 15 n Recent report from Terada T, Japan n n 37 cases of GI lymphoma M: F 20: 17 Median age 69 yr (4689) Types n Gastric 25 (68%) n Small bowel 6 (16%) n Colon 6 (16%) Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012; 2(3): 194 -200.

Gastrointestinal Lymphoma n Types B-cell 35 (95%) n T-cell 2 (5%) n Gastric NHL 25 n DLBCL 11 n MALT 14 n Small intestine n DLBCL 4 n PTCL 2 n Colon 6 n DLBCL 5 n FL 1 n n Clinical diagnosis of colon NHL at first n GIST 1 n Colon carcinoma 4 n Colon polyp 1 n No cases of n n n Hodgkin lymphoma Burkitt lymphoma Mantle cell lymphom Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012; 2(3): 194 -200.

Primary FL of GI tract: Massachusetts General Hospital, 1995 -2010 n Excluded cases n n n History of FL outside GI tract Widespread lymphoma Distant nodal disease within 6 months Multifocal diseases Splenic involvement FL in transformation Misdraji J, et al. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol 2011; 35: 1255 -63.

Presenting Symptoms/ Finding n Symptoms n Abdominal pain and nausea, vomiting (12), bowel obstruction n Intussuspection (1) n Incidental finding (13) on investigation of n Reflux symptoms or Barrett esophagus n Screening for colorectal cancer n Resection of sigmoid carcinoma n Macroscopic findings n White patches or plaques n Mucosal nodularity or granularity n Nodules n Polyp (1, 2, 3) n Submucosal mass n Thickening of wall or folds Misdraji J, et al. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol 2011; 35: 1255 -63.