Post written by Yuki Tanisaka, MD, PhD, from the Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

We report our experience with confocal laser endomicroscopy (CLE) imaging of lymphoma of the duodenal papilla with the corresponding histopathologic images.

Our patient was an 83-year-old man with an endoscopic finding of a depressed lesion of the papilla. A lack of glandular structure was observed in narrow-band imaging. Subsequently, fluorescein-dripping CLE was performed using probe-based CLE (pCLE) (GastroFlex, Cellvizio; Mauna Kea Technologies, Paris, France). The sizes of the tumor cells, as assessed via pCLE and histological examination, were roughly the same.  The pCLE image seemed to reflect the histological findings.

Because lymphoma of the duodenal papilla is rare, to our knowledge, this is the first report on this subject. The findings observed in this case are similar to those described in our previous reports wherein pCLE was also used to identify lymphoma, suggesting that this pCLE finding is common to lymphoma. If the endoscopist finds a depressed lesion that is difficult to diagnose, pCLE is useful in distinguishing if it is benign, cancer, or lymphoma.

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