A rare case of multiple lymphomatous polyposis with widespread involvement of the gastrointestinal tract

Esophageal involvement of mantle cell lymphoma presenting with multiple lymphomatous polyposis: A single-center study

BACKGROUND

In addition to nodal lesions, over 30% of mantle cell lymphomas (MCLs) also have gastrointestinal involvement, characteristically presenting as multiple lymphomatous polyposis (MLP), which rarely involve the esophagus. Most related papers have been case reports, and no comprehensive studies have been conducted; thus, the actual clinical situation has remained unknown for a long time.

AIM

To elucidate the actual clinical situation of esophageal involvement of MCL presenting with MLP, including its prognosis.

METHODS

From January 2001 to December 2021, among MCL patients whose gastrointestinal lesions were histopathologically confirmed by endoscopic biopsy at our center, 6 patients with MLP in the esophagus were selected. We retrospectively examined the clinical features of these patients, including their prognosis.

RESULTS

In all patients, multiple lesions were present in the gastrointestinal tract other than the esophagus and in the lymph nodes throughout the body, and most patients also had lesions involving the bone marrow or spleen. Most of the treatments include chemotherapy, with a 50% survival period of less than 2 years and a 5-year survival rate of approximately 30%, indicating a poor prognosis.

CONCLUSION

Patients with esophageal involvement of the MCL who presented with MLP had a large tumor burden and poor survival.

Colonic lymphomatous polyposis mantle cell lymphoma: a case report and review of literature

INTRODUCTION

Mantle cell lymphoma is a rare lymphoma of the gastrointestinal tract that may present as multiple lymphomatous polyposis. We report a case of lymphomatous polyposis with a review of the literature.

CASE REPORT

A 56-year-old man of Black ethnicity and Ivorian nationality with no relevant past medical history, consulted for a sudden onset symptoms of gastrointestinal obstruction, which evolved over 2 days. Macroscopic examination revealed the presence of multiple polyploid formations of the colonic mucosa. Histology showed diffuse lymphomatous proliferation of submucosa consisting off small lymphoid cells with a hyperchromatic crenelated nucleus, suggesting lymphomatous polyposis. Immunohistochemical examination showed expression by the tumor cells of antibodies to CD20, CD5, Bcl2, and cyclin D1. They did not express antibodies to CD10 and CD23. The Ki67 proliferation index was 25%. We have thus retained the diagnosis of mantle cell lymphomatous polyposis.

CONCLUSION

Multiple lymphomatous polyposis is a rare entity characterized by the presence of numerous gastrointestinal polyploid lesions sometimes involving several segments of the gastrointestinal tract. Typical lymphoma presenting as lymphomatous polyposis is mantle cell lymphoma; although, other tumors may have this aspect.

A Unique Presentation of Primary Intestinal MALT Lymphoma as Multiple Lymphomatous Polyposis

Multiple lymphomatous polyposis is considered to be a rare condition, with most of the cases being extranodal counterpart of mantle cell lymphomas. We report a rare case of multiple lymphomatous polyposis of the gastrointestinal tract in which the patient presented with abdominal pain and bloody diarrhea. Computer tomography of the abdomen showed circumferential wall thickening with intramural mass involving caecum & ascending colon with enlarged pericolonic lymph nodes. The patient underwent right hemicolectomy. Immunohistologic findings were characteristic of MALT lymphoma. Microscopic examination of polypoidal masses and mesenteric lymph nodes revealed infiltration by pleomorphic, atypical lymphoid cells which were CD20 positive and negative for CD3, CD10, Cyclin D1. Lymphoepithelial lesions were also noted. Careful endoscopic evaluation and histopathological review along with an immunohistochemical panel is extremely useful for accurately diagnosing such cases and avoiding unnecessary surgery and inappropriate therapy.

Decreased numbers of vascular networks and irregular vessels on narrow-band imaging are useful findings for distinguishing intestinal lymphoma from lymphoid hyperplasia

BACKGROUND

No method for sufficiently making the differential diagnosis of intestinal lymphoma resembling lymphoid hyperplasia (LH) on endoscopy has yet been established.

OBJECTIVE

The aim of this study was to evaluate the usefulness of narrow-band imaging (NBI) in diagnosing intestinal lymphoma.

DESIGN

Prospective study.

SETTING

Single-center study.

PATIENTS

Sixty-one patients with primary or systemic lymphoma were enrolled in this study.

INTERVENTIONS

The terminal ileum and entire colon were observed by using conventional endoscopy. NBI was subsequently performed when small polypoid lesions were detected. A decrease in the number of vascular networks (DVNs) and the presence of irregular vessels on the surface of the epithelia were defined as characteristic findings of intestinal lymphoma. The diagnostic accuracy of these 2 findings in distinguishing intestinal lymphoma from LH was examined.

MAIN OUTCOME MEASUREMENTS

The ability to use NBI to distinguish intestinal lymphoma from LH.

RESULTS

Two hundred ninety-four small polypoid lesions, including 59 lymphomas and 235 LH lesions, were detected. The rates of detecting DVNs and the presence of irregular vessels were significantly higher in the lymphoma samples (81.4% and 62.7%) than in the LH samples (25.5% and 4.7%). Based on these findings, the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values for differentiating intestinal lymphoma from LH were 88.8%, 62.7%, 95.3%, 77.1%, and 91.1%, respectively, which are significantly higher than those of conventional endoscopy.

LIMITATIONS

Single-center study.

CONCLUSION

DVNs and the presence of irregular vessels on NBI are thus considered to be useful findings for differentiating intestinal lymphoma from benign LH.

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.

A rare case of mantle cell lymphoma as lymphomatous polyposis with widespread involvement of the digestive tract

Lymphomatous polyposis of the gastrointestinal tract is rare. It refers to a heterogeneous group of small B-cell lymphomas including mantle cell lymphoma, follicular lymphoma and MALT lymphoma. It is characterized by the presence of multiple lymphomatous polyps along one or more segments of the digestive tract. Clinical symptoms are non-specific. We herein report the case of a 74-year old man initially admitted for an upper and lower gastrointestinal endoscopy to explore a positive Hemoccult test. The endoscopy revealed multiple polyps all along the gastrointestinal tract. Histopathological study showed a diffuse lymphomatous proliferation of small B-cells whose immunohistochemical features were compatible with a mantle cell lymphoma. Tumoral B-cells showed a positivity of cyclin D1 markers but negativity for CD5. Immunochemotherapy with R-CHOP (rituximab, cyclophosphamide, adriamycine, vincristine and prednisone) was initiated. Based on this case study, the pitfalls of gastrointestinal tract lymphomatous polyposis diagnosis, prognosis and treatment options are discussed.

Non-polypoidal, synchronous mantle-cell lymphoma of small intestine: a rare case

Herein is reported the case of a mantle cell lymphoma (MCL) with synchronous double intestinal location. A 74 - year old male presented with mild abdominal pain. CT scan imaging indicated invasion of lateral intestinal cavity by large mass formation. Exploratory laparotomy was performed and two solid extra-mural masses were isolated and excised. Histology revealed non- polypoid double synchronous lymphoma of mantle cell origin, an unusual presentation of the disease.

Endoscopic follow-up of 3 cases with gastrointestinal tract involvement of mantle cell lymphoma

Gastrointestinal (GI) tract involvement of mantle cell lymphoma (MCL) presents as a variety of forms, ranging from multiple lymphomatous polyposis (MLP) to a slight mucosal change. We report 3 cases with GI tract involvement of MCL who were followed-up by endoscopy. The present study shows three new informations. MLP of the esophagus is rare, but it was observed in two of 3 patients who were extensively involved by MCL. Endoscopic follow-up in one patient suggested that lymphoma cells of MCL had invaded the lamina propria to submucosal layer before MLP developed. Two of the 3 cases showed a favorable clinical course with single-agent rituximab therapy.

[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.

Synchronous primary gastric mantle cell lymphoma and early gastric carcinoma: a case report

Mantle cell lymphoma (MCL) commonly invades the gastrointestinal (GI) tract. However, primary GI MCL is rare. We experienced a case of synchronous early gastric cancer (EGC) with primary gastric MCL found as a single early lesion rather than as multiple lymphomatous polyposis. An EGC was found in the cardia of a 64-year-old male on a routine GI endoscopic examination. A specimen obtained by total gastrectomy revealed another slightly elevated lesion in the pylorus. Microscopically, monotonous small- to medium-sized atypical lymphocytes with angulated nuclei formed a mass beneath the gastric mucosa. On immunohistochemical staining, the tumor cells revealed strong positivity for cyclin D1, positivity for both CD20 and bcl-2, and weak positivity for CD5, suggesting MCL. Clinically, there was no lymphoma in any other part of the body. This is the first case of an EGC accompanying a primary gastric MCL. Further investigation of a relationship between MCL and EGC and of factors that may affect GI involvement of MCL is necessary.

Evaluation of benign and malignant rectal lesions with CT colonography and endoscopic correlation

Colorectal carcinoma is a significant cause of death from cancer in the United States, and early detection and treatment are critical. Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that is a potential alternative to conventional colonoscopy for colorectal cancer screening. Rectal disease (eg, polyps, cancerous lesions, extramucosal lesions, inflammatory disease) can be especially challenging to diagnose with CT colonography because of several factors that can simulate or obscure the disease (eg, over- or underdistention, rectal tube, stool, artifacts). Familiarity with the spectrum of rectal diseases and with the potential pitfalls and technical limitations of CT colonography will help minimize interpretative and perceptual errors.