St. Louis University Hospital St. Louis, MO, United States
Anuj Chhaparia, MD, Tim Brotherton, MD, Vivian Hathuc, DO, Katie Schroeder, MD St. Louis University Hospital, St. Louis, MO
Introduction: Mantle Cell Lymphoma (MCL) is an uncommon form of non-Hodgkin Lymphoma with variable presentations. MCL is due to a translocation (11;14)(q13;q32) that results in an overexpression of cyclin D1, which plays a prominent role in the regulation of the cell cycle. MCL of the gastrointestinal tract typically only occurs with widespread disease.
Case Description/Methods: We describe a case of 40-year-old man with no significant past medical history who presented for evaluation of chronic diarrhea for six months duration and a thirty pound weight loss. His physical exam was normal. A serologic and stool work-up showed erythrocyte sedimentation rate of 11 MM/HR (0-15 MM/HR), C-Reactive protein of 1.0 mg/dL ( < /= 0.5 mg/dL), and fecal calprotectin of 575 ug/g ( < /= 49 ug/g). Infectious work up was negative. The patient subsequently underwent a colonoscopy with biopsies. Notable endoscopic findings included: Inflammation, nodularity, and erythema of the distal terminal ileum, pan-colonic moderate colitis with mucosal erythema, cobblestoning, and erosions and ulcerations (Figure 1). These endoscopic findings were concerning for inflammatory bowel disease. However, pathology report surprisingly showed mantle cell lymphoma (Figure 1). He underwent a positron emission tomography scan which showed widespread systemic involvement with the most prominent area of gastrointestinal intensity being the rectosigmoid region of the colon. The patient was ultimately diagnosed with stage IVa MCL.
Discussion: The estimated rate of involvement of the gastrointestinal tract in patients with MCL is in the range of 30%. Some presenting symptoms include abdominal pain, gastrointestinal bleeding and diarrhea, with many patients not experiencing any gastrointestinal symptoms. A review in 2010 by Iwamuro et al found that the most common endoscopic manifestation in the colon was multiple lymphomatous polyposis followed by the appearance of protruded tumors or lesions (1). In summary, our case represents a very unusual endoscopic manifestation of MCL that was initially thought to be inflammatory bowel disease.
Iwamuro M, Okada H, Kawahara Y, et al. Endoscopic features and prognoses of mantle cell lymphoma with gastrointestinal involvement. World J Gastroenterol. 2010;16(37):4661-4669.
Figure: Endoscopic findings of erythema, nodularity, erosions and ulcerations. Hematoxylin and eosin staining of the colon on low power shows nodular expansion of the mucosa and submucosa by an atypical lymphoid infiltrate.
Anuj Chhaparia indicated no relevant financial relationships.
Tim Brotherton indicated no relevant financial relationships.
Vivian Hathuc indicated no relevant financial relationships.
Katie Schroeder indicated no relevant financial relationships.
Anuj Chhaparia, MD, Tim Brotherton, MD, Vivian Hathuc, DO, Katie Schroeder, MD. P0174 - Mantle Cell Lymphoma of the Colon Masquerading as Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.