Endorectal sonographic appearances of rectal MALT lymphoma, its response to therapy, and local recurrence

Endorectal sonography may significantly help to evaluate rectal lymphoma. W e report the sonographic findings in a case of rectal non-Hodgkin's MALT (m ucosa-associated lymphoid tissue) lymphoma, including the monitoring of res ponse to therapy and confirmation of recurrence, in a 45-year-old man. On e ndorectal sonography of the rectal wall, the mucosa was markedly thickened to 1.1 cm and was diffusely hypoechoic and risen into multiple polypoid fol ds. The submucosa and muscularis propria appeared normal. Multiple lymph no des were visualized in the perirectal fat; they were homogeneously hypoecho ic, were round or oval, and ranged from 1.0 cm to 2.6 cm. Endoscopic biopsi es revealed a grade I non-Hodgkin's MALT lymphoma. Following chemotherapy, endorectal sonography showed that the surface of the rectal mucosa had a sm oother appearance and near-normal thickness, but lymph nodes, although smal ler, remained visible in the perirectal fat. Four months later, endorectal sonography demonstrated a local relapse of disease, with significant thicke ning of the rectal mucosa and multiple lymph nodes visible in the perirecta l fat. Following high-dose chemotherapy for the recurrence, endorectal sono graphy demonstrated a near-normal appearance of the rectal mucosa. (C) 2001 John Wiley & Sons, Inc.