Introduction: Mantle cell lymphoma is one of the types of B-cell non-Hodgkin’s lymphoma due to overexpression of Cyclin D1 in the setting of chromosomal translocation t(11:14). Extranodal involvement can be seen with the disease which includes the gastrointestinal tract in up to 20% of patients. MCL is usually aggressive with findings of advanced disease on diagnosis including lymphadenopathy, splenomegaly, and bone marrow involvement. Due to this advanced nature, most patients are significantly symptomatic at diagnosis. We report a case of a 67-year-old male patient who presented asymptomatically for routine colonoscopy found to have gastrointestinal mantle cell lymphoma.
Case Description/Methods: A 67-year-old man with no relevant past medical history presented to discuss colonoscopy for colon cancer screening. He was asymptomatic with no previous colonoscopy and no family history of malignancy. He underwent colonoscopy which was remarkable showing pancolonic nodular polypoid mucosa with significant nodular enlargement of the IC valve. Segmental biopsies throughout the colon returned as colonic mucosa with prominent lymphoid aggregates. Biopsies of the IC valves showed mild inflammation. Given the peculiar nature of the endoscopy and biopsy results, a CT of the abdomen was ordered to help further elucidate the cause of the patient’s findings. CT scan showed an enlarged polypoid 4.9cm ileocecal valve with splenomegaly and associated adenopathy. The patient was scheduled for a repeat colonoscopy and the terminal ileum and IC valve were biopsied extensively. However, biopsies this time were sent for lymphoma panel testing given the CT scan findings that were previously described. Biopsies returned consistent with MCL showing diffuse atypical lymphoid proliferation with irregular nuclear contours. On immunohistochemical staining, the atypical lymphocytes were positive for CD20, Cyclin-D1, CD5, and BCL2. The patient was referred to oncology for further evaluation.
Discussion: Mantle cell lymphoma is a subtype of non-Hodgkins lymphoma (NHL) making up about 7% of NHL in adults. MCL predominantly presents with advanced disease. Gastrointestinal involvement during endoscopic evaluation is rarely the presenting sign, as in this patient, which most commonly manifests as diffuse lymphomatous polyposis. Recognizing this endoscopic finding is important as it can expedite diagnosis by appropriately analyzing tissue obtained through biopsy and attaining further imaging to confirm the suspicion of lymphoma.
