Diagnosis of follicular lymphoma of the small bowel by video capsule endoscopy.

A 61 year-old asymptomatic male was included in the colorectal cancer screening programme. As fecal occult blood tests were positive, a colonoscopy was carried out, but the examination was not complete due to low tolerance to the procedure. Following the established protocol in our center a colonography by computed tomography (CT-colonography) was made. Colonic lesions were not observed but multiple mesenteric lymph nodes were diagnosed instead (Fig. 1). After this, a positron emission tomography (PET) described multiple abdominal nodes with enhanced metabolism. With the clinical suspicion of a lymphoproliferative process, we decided to carry out an endoscopic examination of the small bowel with video capsule in which we observed an amount of whitish nodules and small polipoid lessions (Fig. 2), located between the medium portion of jejunum and ileon. In the distal portions of the small bowel, the lesions were bigger, with thickened mucosal folds, and some of these nodules were ulcerated (Fig. 3). According to the reports in literature, these findings suggested a lymphoproliferative disorder of the small bowel (1). The specimens obtained by enteroscopy and CT-guided fine-needle aspiration confirmed the diagnosis of studium IIA follicular lymphoma.