Duodenal mucosa-associated lymphoid tissue lymphoma masquerading as an ulcer scar

Abstract

A 62-year-old man was referred to our clinic because of gastric malignancy found on a periodic medical check-up. He had no specific symptoms or signs. Physical examination and routine laboratory studies were normal. Esophagogastroduodenoscopy revealed early gastric cancer (EGC) in the antrum, and there was an additional reddish ulcer scar with fold convergence in the anterior wall of the duodenal bulb. Unlike typical ulcer scar tissue, its mucosa showed patchy erythema and friability. Blood oozed after light touch by the scope ([Fig. 1]). Thus, a biopsy specimen was also taken from the duodenal bulb. Interestingly, histology showed infiltration of atypical lymphocytes with lymphoepithelial lesions. Endoscopic ultrasound (GF-UM 2000, Olympus, Tokyo, Japan) demonstrated hypoechoic wall thickening of the second sonographic layer and focal interruption of the third layer of the duodenum ([Fig. 2]). There were no abnormalities in bone marrow biopsy, abdomen and chest computed tomography scan. He underwent subtotal gastrectomy 4 weeks later. Histological examination revealed that atypical lymphocytes infiltrated diffusely into the mucosal and submucosal layer of the duodenal bulb ([Fig. 3]).