Small intestine & ampulla


Immunoproliferative small intestinal disease (ISID)

Topic Completed: 1 August 2012

Minor changes: 19 April 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Immunoproliferative small intestinal disease (ISID)

Hanni Gulwani, M.B.B.S.
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Cite this page: Gulwani H. Immunoproliferative small intestinal disease (ISID). website. Accessed November 29th, 2021.
Definition / general
  • Also called Meditteranean lymphoma, Middle Eastern lymphoma
  • More common among non-European Jews, Middle Eastern Arabs, South African blacks
  • B cell lymphoma that arises in background of chronic diffuse mucosal plasmacytosis, with IgA heavy chain synthesis (no variable chain synthesized)
Clinical features
  • Many have preexisting malabsorption
  • May initially respond to antibiotics
  • Often due to Campylobacter jejuni, another human pathogen responsible for immunoproliferative states (N Engl J Med 2004;350:239)
Case reports
Gross description
  • Low grade: nonflattened mucosa
  • High grade: diffusely thickened folds with small nodules in distal duodenum / proximal jejunum
Microscopic (histologic) description
Low grade:
  • Heavy lymphoplasmacytic infiltrate by mature cells

High grade:
  • Resembles diffuse large cell lymphoma with plasmacytoid features
  • May have starry sky pattern, follicular hyperplasia
Microscopic (histologic) images

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Various images

Positive stains
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