How would you approach a Follicular grade 1-2 NHL found on a terminal ileum biopsy with otherwise negative EGD and colonoscopy and contrast enhanced CT scan?

At our facility, we have treated a significant number of patients with low grade lymphoma isolated to a single fixed site within the GI tract with excellent long term results. It is worth considering a dose of 2400 rads to the involved site.

At times, intestinal (duodenal) FL can be indolent and observation is appropriate. However, with any symptoms or bleeding and given the odd location of this lesion, i would consider rituximab given the high response rate and limited side effects wtih this approach.