Duodenal Follicular Lymphoma... or not?
I has a single medium sessile polyp found in the 2nd part of my duodenum, incidentally during endoscopy. Lab work came back as low grade B-cell lymphoma, follicular phenotype. Of course, this scared the crap out of me. I went to a lymphoma specialist and they said it was duodenal follicular lymphoma. They did bloodwork and a PET scan which was all negative and showed nothing else concerning. They said even if it were not already removed, they would still just watch it and no need to for any treatment. My gastro did remove it (piece meal) so I am hoping it is gone gone, but will be having a follow-up endoscopy within the year to monitor. The Dr did not seem to question the lab report at all. I know these big labs have to err on the side of caution, since if they missed something, it could be a big liability for them.
My real issue is... I have been researching, and some of the histology has me questioning whether it is really DFL or one of the differential diagnosis: reactive lymphoid aggregate/hyperplasia, in-situ follicular neoplasia, other?. The reason I am questioning it, is because some of the histology seems to point to these other things more than DFL.
- Finding: Infiltration of the mucosa by a monotonous population of small lymphoid cells. No evidence of large cell transformation.
- Lesional cells diffusely positive for:
- CD20+
- CD2+
- CD6+
- Negative for
- *CD10-
- CyclinD1-
- CD43/CD3/CD5: highlight background T-cells
- *CD23 highlight lymphoid meshwork
- Ki-67: 20-25% proliferation rate
- **Kappa and Lambda ISH: show a polytypic staining pattern
- **FISH IGH BCL2 t(14;18): 13% positive nuclei
The */** items are the ones that my research says could be pointing to a non-DFL diagnosis. I am just driven to really confirm what I have, since it could have influence on future monitoring, treatment, etc.
I am hoping that an expert can help me with the following questions to help guide me to an answer:
- Am I correct that the ** items open the door to other possible diagnosis?
- Are there other tests or analysis that would be prudent to do on the tissue to confirm what this actually is? Is that even possible with such a small sample that has already been stained/used?
- With a piece meal removal, how likely to return? For future monitoring endoscopy, if something reappears, will a lymphoma specialist be able to fully remove and test for margins during the endoscopy?
Thank you!