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Int J Clin Exp Pathol 2013;6(5):951-956

Case Report
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT
lymphoma) of the ileum in a 35-year-old Japanese woman

Tadashi Terada

Departments of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan

Received March 15, 2013; Accepted April 3, 2013; Epub April 15, 2013; Published May 1, 2013

Abstract: MALT lymphoma of the ileum is extremely rare: only several cases have been reported. A 34-year-old woman presented abdominal
pain and melena. Colorectal and small intestinal endoscopes revealed multiple tumors and ulcers of the entire ileum. Biopsy was taken.
Histologically, the biopsy consisted of 6 tissue specimens taken from the various sites of the ileum. All the tissue specimens showed
infiltration of small atypical cells resembling centrocyte-like cells (CLC). Immunoblastic cells were scattered, though the number was scant.
Monocytoid, plasma cell differentiation, and germinal centers were seen. Lymphoepithelial lesions (LEL) were scattered. Some small atypical
lymphocyte were destructive the vessels and stromal tissues. Giemsa and Gram stains demonstrated no Helicobacter pylori and any bacteria.
Immunohistochemically, the atypical small lymphocytes were positive for vimentin, but negative for various kinds of cytokeratins (CKs), EMA,
CEA and CA19-9. The CK highlighted the LEL. They were positive for CD45, and B-cell markers (CD20, CD79a, CD10, CD23, bcl-2). CD138-
positive plasma cells were seen in large number. CD68-positive macrophages were scattered. CD30- and CD15-positive immunoblastic cells
were scattered. Most of the lymphoid cells were negative for T-cell markers (CD3, CD4, CD5, CD45RO, and CD43) and negative for NK cell
markers (CD56 and CD57). The lymphoid cells were positive for κ-chain but negative for λ-chain; thus the light chain restriction was seen. TdT
and cyclin D1 were negative. P53 was positive and Ki-67 labeling index was 67%. The lymphoid cells were negative for neuroendocrine
markers (NCAM, NSE, chromogranin, and synaptophysin). The pathological diagnosis was MALT lymphoma of the ileum. Post-biopsy imaging
techniques including CT, MRI, PET endoscope and gallium scintigraphy identified no tumors and no lymphadenopathy in the body except the
ileum. The stomach was free from MALT lymphoma. She was treated by low dose chemotherapy and strictly followed up. (IJCEP1303035).

Keywords: Ileum, MALT lymphoma, histopathology, immunohistochemistry

Address correspondence to: Dr. Tadashi Terada, Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shimizu-Ku,
Shizuoka 424-8636, Japan. Phone: +81-54-336-1111; Fax: +81-54-334-1173; E-mail: piyo0111jp@yahoo.co.jp