Introduction: Mantle cell lymphoma is a rare B-cell Non-Hodgkins lymphoma that involves the gastrointestinal tract with the typical findings of a mass lesion associated with multiple other lymphomatous polyps.
Case Description/Methods: We present a 73 year old woman with a history of hypertension who presented for a surveillance colonoscopy. She had a tubular adenoma removed five years prior and presented without any overt gastrointestinal signs, symptoms or evidence of weight loss. On colonoscopy a large lobulated mass lesion was noted in the cecum, and biopsies confirmed it to be a malignant B-cell lymphoma, mantle cell type. Immunohistochemical staining showed an atypical lymphoid infiltrate CD20+, PAX-5+ and diffusely positive for CD5, CD43, cyclin-D1 and BCL-2 and negative for CD3, CD10, pankeratin and BCL-6, with a proliferation index of 35%. A CT showed a large mass involving the cecum, ileocecal valve and possibly the distal aspect of the terminal ileum, as well as large right lower quadrant, periportal and gastrohepatic lymphadenopathy. Oncology service initiated chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R CHOP) and after 3 cycles a repeat PET/CT showed complete regression with resolution of the cecal and ileal mass as well as all previously noted lymphadenopathy. The patient has remained asymptomatic throughout the process and continues to be clinically stable and disease free 16 months after her initial diagnosis.
Discussion: Mantle cell lymphoma generally has a poor prognosis and typically does not present as an isolated cecal mass without evidence of other colonic involvement of multiple lymphomatous polyps. This case demonstrates that a solitary colonic mantle cell lymphoma can be found as an incidental finding, in an asymptomatic patient, with total resolution of the lymphoma after appropriate treatment.
.jpg "Diana Lei S. Dy, RN, BSN photo")