case_images: PMC7563037_01
case_images: Esophagogastroduodenoscopy images. Multiple white irregularly shaped depressed lesions with partial redness are seen in the gastric body (a, b). Magnified narrow-band imaging images show the disappearance of the pit structure and elongated microvessels within the depressed areas (c, d, arrows). These microstructures are typical of gastric MALT lymphoma. MALT: mucosa-associated lymphoid tissue.
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case_images: PMC7563037_01_CRIGM2020-8893604.001.jpg
case_images: fig1
case_images: Esophagogastroduodenoscopy revealed multiple white irregularly-shaped depressed lesions with partial redness in the gastric body (Figures 1(a) and 1(b)). Narrow-band imaging with magnification showed disappearance of the pit structure and elongated microvessels within the depressed areas (Figures 1(c) and 1(d), arrows), which are the typical features of gastric MALT lymphoma.
case_images: Images of the pathologic analysis of the gastric lesion. Small to medium sized lymphoid cells are observed in the biopsy specimens (a). These cells are positive for CD20 (b) and negative for CD3 (c). Immunostaining for cytokeratin (CAM5.2) shows the formation of lymphoepithelial lesions (d). Gastric MALT lymphoma was diagnosed.
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case_images: PMC7563037_01_CRIGM2020-8893604.002.jpg
case_images: fig2
case_images: Biopsy of the gastric lesion revealed the infiltration of small- to medium-sized lymphoid cells (Figure 2(a)), which were positive for CD20 (Figure 2(b)) and negative for CD3 (Figure 2(c)). Immunostaining for cytokeratin (CAM5.2) showed the formation of lymphoepithelial lesions (Figure 2(d)).
case_images: Colonoscopy images. Coarse reddish mucosa with yellowish-white pus-like deposits is observed in the splenic flexure (a). Atrophic mucosa with multiple ulcer scars is also seen in the descending to sigmoid colon region (b-d). These endoscopic findings are consistent with those for ulcerative colitis.
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case_images: fig3
case_images: Colonoscopy revealed coarse reddish mucosa with yellowish-white pus-like deposits in the splenic flexure (Figure 3(a)), which are the representative endoscopic features of ulcerative colitis.
case_images: Colonoscopy images of the cecum. A reddish flat elevated lesion is seen (a). Magnified linked color imaging image shows elongated microvessels (b). Partial disappearance of the pit structure and elongated microvessels are observed in the narrow-band imaging image (c). Indigo carmine spraying reveals that the areas with no pit structures are slightly depressed (d). Papular lesions resembling lymphoid follicles are observed in the cecum and ascending colon (e). Although we initially considered this lesion to be involved with the MALT lymphoma, the final diagnosis was appendiceal orifice inflammation in ulcerative colitis.
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case_images: fig4
case_images: In addition, a reddish flat elevated lesion was observed in the cecum (Figure 4(a)). Linked color imaging with magnification showed elongated microvessels (Figure 4(b)). The partial disappearance of the pit structure and elongated microvessels were observed on narrow-band imaging (Figure 4(c)). Indigo carmine spraying revealed that the areas with no pit structures were slightly depressed, as shown by the pooling of the indigo carmine dye (Figure 4(d)). Papular lesions resembling the lymphoid follicles were observed in the cecum and ascending colon (Figure 4(e)).
case_images: Flow cytometry analysis results. We used an endoscopic biopsy specimen for flow cytometry analysis; light chain restriction was not observed. CD19+ and CD20+ cells are gated (a), and light chain expression analysis reveals an almost equal number of Ig kappa- and Ig lambda-producing cells (b).
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case_images: fig5
case_images: However, flow cytometry analysis using an endoscopic biopsy specimen showed no light chain restriction (Figure 5).
case_images: Images of the pathologic analyses of the cecal lesion. Inflammatory cell infiltration, mainly consisting of mononuclear cells, in addition to some neutrophils is observed in the biopsy specimens (a). Although CD20-positive lymphocytes are predominant (b), CD3-positive cells are observed as well (c). Predominance of neither Ig kappa (d) nor Ig lambda (e) is observed on staining.
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case_images: PMC7563037_01_CRIGM2020-8893604.006.jpg
case_images: fig6
case_images: On pathological analysis of the biopsied specimens, inflammatory cell infiltration, mainly consisting of mononuclear cells, in addition to some neutrophils was observed (Figure 6).