Unusual abdominal tumors: case 4. Multiple lymphomatous polyposis in mantle cell lymphoma

Multiple lymphomatous polyposis with diffuse involvement of the gastrointestinal tract. Case report

The gastrointestinal tract is the predominant site of extranodal non-Hodgkin lymphomas. Multiple lynphomatous polyposis is a type of appearance of mantle cell lymphoma. It is characterized by multiple polypoid lesions involving long gastrointestinal tracts and it accounts for only approximately 1-2% of non-Hodgkin lymphomas. A 78 years old patient was admitted to our Department of General Surgery with rectal bleeding, abdominal pain and weight loss. Multiple lymphomatous polyposis was detected by endoscopy. Endoscopic biopsies confirmed the diagnosis of mantle cell lymphoma. The patient was transferred to the Department of Hematology for cycles of chemotherapy.

[Mantle cell lymphoma: case report]

Mantle cell lymphoma (MCL) is a moderately aggressive disease, which is not curable with chemo-immunotherapy. The median survival duration is short, approximately three years. Most of the patients have advanced stage disease at the time of diagnosis. Fifty percent of the patients show infiltration of the bone marrow, in 25% of the MCL patients the gastrointestinal tract is involved, in 25% of patients leukaemic transformation occurs. The tumor cells express pan-B-cell markers and the T-cell marker CD5. The overexpression of cyclin D1 was found as another marker for mantle cell lymphoma. Combined chemotherapy, chemo-immunotherapy, autologous peripheral stem cell (and allogenous) transplantation is the treatment of choice. Our two patients had prolonged survival, in spite of missing the best first line therapy. The survival time after the complex treatment (chemo-immunotherapy, irradiation, surgical intervention, autologous stem cell transplantation) was 80 and 90 months, respectively. In addition to the history of two patients, authors review the current treatment options in mantle cell lymphoma.