NON'HODGKINS'LYMPHOMA'INVOLVING'THE'DUODENUM'I'A'CASE'SERIES'
POSTER'45'
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Arun!V1,!Geetha!N1,!Sreejith!Nair1,!Prakash!N!P1,!Deepa!Philip1,!Sugeeth!M!T1!and!Priya!Mary!Jacob2!
!
(1)Department! of! Medical! Oncology,! Regional! Cancer! Center,! Thiruvananthapuram,! India,!
(2)Department!of!Pathology,!Regional!Cancer!Center,!Thiruvananthapuram,!India!
!
INTRODUCTION!
Gastrointestinal!(GI)!tract!is!the!most!common!extra!nodal!site!of!Non!Hodgkins!lymphoma!
(NHL)!accounting!for!10%!of!NHL.!Duodenum!is!a!very!rare!site!of!involvement.!We!describe!
a!series!of!eight!patients!who!were!diagnosed!with!NHL!involving!the!duodenum.!
MATERIALS'AND'METHODS!
This! is! a! retrospective! study! of! 8! patients! diagnosed! with! NHL! involving! the! duodenum!
treated! at! the! department! of! Medical! Oncology,! Regional! Cancer! Center!
Thiruvananthapuram!from!January!2002!to!December!2019.!
RESULTS!
Eight! patients! were! diagnosed! with! NHL! involving! the! duodenum! from! January! 2002! to!
December! 2019.! The! median! age! at! presentation! was! 42! years! (range! 32J62! years).There!
were! seven! males! and! one! female.! Abdominal! pain! was! the! most! common! presenting!
symptom! with! median! duration! of! 4! months.! One! patient! had! obstructive! jaundice! and!
another! had! melena! at! presentation.! Three! patients! had! B! symptoms.! All! the! patients!
underwent!upper!GI!endoscopic!evaluation!which!showed!either!nodularity!or!ulceration!of!
duodenum.! Computerized! Tomography! of! thorax! abdomen! and! pelvis! (CT)! was! done! as!
staging!work!up!for!all!.!Patients!were!staged!as!per!Ann!Arbor!criteria.!Three!had!Stage!I!
disease,! one! had! stage! III,! and! four! had! stage! IV! disease.! Diffuse! Large! B! cell! Lymphoma!
(DLBCL)!was!the!most!common!histology,!seen!in!four!patients!(Patients!1J4).!One!patient!
each!had!Mucosa!associated!lymphomaJMALT!lymphoma!(Patient!5),!Mantle!cell!lymphoma!
(Patient!6),!Burkitt's!lymphoma!(Patient!7)!and!Follicular!lymphoma!(Patient!8).!
Patients! diagnosed! with! DLBCL! received! chemoJimmunotherapy! with! 6! cycles! of! RJCHOP!
(Rituximab,! Vincristine,! Doxorubicin,! Cyclophosphamide! and! Prednisolone).! Patient! 1!
underwent!whipples!resection!prior!to!RJCHOP!and!is!alive!in!remission!at!18!years.!Patient!2!
is! alive! in! remission! at! 5! years.! Patient! 3! had! progressive! disease! while! on! treatment! and!
expired.!Patient!4!relapsed!after!a!DFS!10!months!and!expired.!
Patient!5!with!MALT!lymphoma!received!one!course!of!anti!H.Pylori!therapy!and!is!alive!in!
remission! at! 5! years.! Patient! 6! and! 7! with! Mantle! cell! lymphoma! and! Burkitt's! lymphoma!
respectively! died! while! on! treatment! with! RJHCVAD! (Rituximab,! Cyclophosphamide,!
Vincristine,!Doxorubicin,!Dexamethasone,!Cytosine!Arabinoside,!and!Methotrexate).!Patient!
8! with! Follicular! lymphoma! received! 6! cycles! of! RJCHOP! and! is! undergoing! maintenance!
treatment!with!Rituximab.!
CONCLUSION!
NHL!involving!the!duodenum!constituted!0.08%!of!the!NHL!diagnosed!at!Regional!Cancer!
center!Thiruvananthapuram!during!the!study!period.!The!treatment!of!choice!is!chemoJ
immunotherapy!depending!on!the!histology.! !