Reply to Takada et al.

We thank Dr. Takada and colleagues for their comments on our case series describing the usefulness of double-balloon endoscopy (DBE) for diagnosis of jejunoileal involvement in primary gastrointestinal follicular lymphoma (GIFL). In our report, we demonstrated that DBE could visualize jejunoileal follicular lymphoma lesions such as multiple white nodules or white villi that were not detectable by fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET). We therefore concluded that DBE is essential for evaluating the extent of intestinal involvement in primary GIFL. However, we did not assess the efficacy of ¹⁸F-FDG-PET in detecting nodal involvement as we had only two patients with lymph node swelling in our study population; both were negative for FDG deposit [1].

In their letter, Takada et al. report a patient with gastric follicular lymphoma in whom ¹⁸F-FDG-PET was useful in detecting involvement of a small mediastinal lymph node. It has been reported that ¹⁸F-FDG-PET is relatively insensitive for visualization of indolent-type lymphomas, including follicular lymphoma [2]. However, another report showed its usefulness for visualizing primary nodal follicular lymphoma, such as aggressive lymphoma, irrespective of tumor grading [3].

As Takada et al. suggest, ¹⁸F-FDG-PET might be a useful modality for detecting nodal involvement in patients with primary GIFL. However, further analysis will be needed to determine whether nodal involvement in primary GIFL, as in primary nodal follicular lymphoma, can be detected at a reasonably high rate by ¹⁸F-FDG-PET. At the present time, it is recommended that both DBE and ¹⁸F-FDG-PET are carried out to evaluate the extent and the stage of GIFL.

Competing interests: None

References

• 1 Higuchi N, Sumida Y, Nakamura K. et al . Impact of double balloon endoscopy for the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas: a case series.  Endoscopy. 2009;  41 175-178
• 2 Jerusalem G, Beguin Y, Najjar F. et al . Positron emission tomography (PET) with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) for the staging of low-grade non-Hodgkin’s lymphoma (NHL).  Ann Oncol. 2001;  12 825-830
• 3 Wöhrer S, Jaeger U, Kletter K. et al . ¹⁸F-Fluoro-deoxy-glucose positron emission tomography (¹⁸F-FDG-PET) visualizes follicular lymphoma irrespective of grading.  Ann Oncol. 2006;  17 780-784