Henry Ford Hospital Medical Journal


We describe a rare case of a localized primary small intestinal lymphoma with features of both the Mediterranean and the Western type. This case demonstrates the need to regard intestinal lymphoma as a spectrum of diseases with the Mediterranean and the Western types at opposite ends and many variants in between. The role of the plasma cell infiltrate has been interpreted as reactive as well as neoplastic. In our case, both lymphocytic and plasmacytic proliferations spread widely in the intestinal submucosa, extended into muscularis propria and subserosal fat, and involved mesenteric lymph nodes. Direct immunofluorescence demonstrated IgG-kappa both in plasma cells and within the lymphocytic infiltrate. We conclude that both cell types were neoplastic and the lymphoma was of a mixed lymphocytic-plasmacytic type. We also discuss the possibility of a common B cell origin for both cell types and the significance of the production of different immunoglobulins by different intestinal lymphomas.