Clinical Endoscopy

Endoscopic findings are associated with histologic types of primary small intestinal lymphoma: a retrospective study in Japan: Masafumi Kitamura, Mio Sakaguchi, Hirotsugu Sakamoto, Satoshi Shinozaki, Manabu Nagayama, Tomonori Yano, Yusuke Ono, Takuma Kobayashi, Kunihiko Oguro, Shoko Miyahara, Masahiro Okada, Katsuyuki Nakazawa, Keijiro Sunada, Noriyoshi Fukushima, Hironori Yamamoto; Clin Endosc 2026;59(2):298-306. Published online January 29, 2026; DOI: https://doi.org/10.5946/ce.2025.239

Background
/Aims: Although endoscopic diagnosis of primary small intestinal lymphoma (PSIL) is important, the association between endoscopic findings and histologic types remains unclear. This study aimed to evaluate the diagnostic accuracy of endoscopic classifications and biopsies in PSIL.
Methods
We retrospectively reviewed 100 lesions from 49 patients with PSIL who underwent double-balloon enteroscopy between 2005 and 2020. Endoscopic findings were classified into six macroscopic types: polypoid, ulcerative, multiple nodules, diffuse, concentric stenosis, or unclassified.
Results
Of the 100 lesions, 47 were multiple nodules, 32 were ulcerative, 8 were polypoid, 7 were diffuse, 4 were concentric stenosis, and 2 were unclassified. Diffuse large B-cell lymphoma (DLBCL) was mainly ulcerative (72%) or polypoid (75%), whereas follicular lymphoma appeared as multiple nodules (98%) or concentric stenosis (100%) (p<0.001, Cramér’s V=0.41). The ulcerative type was associated with DLBCL (sensitivity, 0.74; specificity, 0.87), and multiple-nodule type were associated with follicular lymphoma (sensitivity, 0.75; specificity, 0.97). The overall diagnostic yield of the biopsy was 95%. Interobserver agreement was substantial (κ=0.69; agreement, 78%).
Conclusions
Endoscopic findings were significantly associated with histologic types. Endoscopic findings and biopsies provide a high diagnostic yield, supporting their central role in the diagnostic management of PSIL.

Citations

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New Diagnostic Approach for Esophageal Squamous Cell Neoplasms Using Linked Color Imaging and Blue Laser Imaging Combined with Iodine Staining: Masato Tsunoda, Yoshimasa Miura, Hiroyuki Osawa, Tsevelnorov Khurelbaatar, Mio Sakaguchi, Hisashi Fukuda, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2019;52(5):497-501. Published online April 16, 2019; DOI: https://doi.org/10.5946/ce.2018.195

Abstract PDF

A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale red lesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine staining demonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purple and green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o’clock position inside the iodineunstained area. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o’clock position and an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine staining produce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. This new method is useful for detailed evaluation of early flat squamous cell neoplasms.

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