Esophagogastroduodenoscopy with magnifying endoscopy and endoscopic ultrasonography (EUS) may have utility in the diagnosis of the gastric involvement of follicular lymphoma (FL), according to the findings of a case report recently published in the Clinical Journal of Gastroenterology.

“There have been few reports of FL involving the stomach, and the macroscopic and microscopic features of gastric FL are not well documented,” the study authors wrote.

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The case report was of a 61-year-old man who underwent esophagogastroduodenoscopy after a contrast-enhanced computed tomography (CT) scan revealed thickening of the upper gastric body wall and multiple mesenteric tumors. Six years prior, swollen gastric folds were identified, and one year before, a diagnosis of Helicobacter pylori infectious gastritis was made.

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Several endoscopic features of gastric lesions of FL were revealed using various endoscopic diagnostic techniques. Esophagogastroduodenoscopy showed swollen gastric folds (with increased gastric mucus secretion) and cobble stone mucosa in the gastric body; magnifying endoscopy with narrow-band imaging revealed branched abnormal vessels that had a tree-like appearance and both an absence and destruction of gastric pits; EUS showed homogeneously hypoechoic thickening of the submucosal layer.

Biopsies were taken of these lesions, leading to a definitive diagnosis of grade 1, stage IV FL that involved the stomach, duodenum, colon, and mesenteric lymph nodes. The patient was treated with combination chemotherapy with bendamustine hydrochloride and rituximab.

“Our present endoscopic findings demonstrate that FL can involve the stomach, either primarily or secondarily, and suggest that detailed endoscopic observation of the upper gastrointestinal tract, including EUS and biopsy, can facilitate early treatment of FL with minimal invasiveness,” the study authors concluded.


Koya Y, Watanabe T, Kume K, et al. Usefulness of magnifying endoscopy and endoscopic ultrasonography for the gastric involvement of follicular lymphoma [published online July 6, 2019]. Clin J Gastroenterol. doi: 10.1007/s12328-019-01015-4