Endoscopic image of gastrointestinal involvement by mantle cell lymphoma

This case study concerns a 78-year-old woman who was examined due to iron deficiency anemia, with no other reported symptoms. Oral iron therapy was prescribed and endoscopic studies were requested. The upper gastrointestinal endoscopy revealed scattered lesions consistent with elevated antral erosions, on top of mild mucosal dyschromia suggestive of chronic gastritis (Fig. 1a). In the duodenum, the finding of multiple sessile lesions of various sizes and with an appearance not suggestive of adenoma was striking (Fig. 1b). The colonoscopy revealed similar lesions to those found in the duodenum, with the largest and sessile lesions located in the distal sections (Fig. 1c and d), and flatter lesions in the ascending colon, giving the mucosa a cobblestone appearance (Fig. 1e). The gastric, duodenal and colonic biopsies identified a mucosa infiltrated by a homogeneous lymphoid proliferation of small, monomorphic cells in a pseudonodular pattern. The ki67 proliferative index was 40% and mantle cell lymphoma infiltration was identified by immunohistochemistry. After diagnosis, the patient was referred to the Haematology Department to complete the extension study and cancer treatment.

Figure 1.

(a) Upper gastrointestinal endoscopy image of the antrum and gastric incisura. (b) Upper gastrointestinal endoscopy image of the second duodenal portion. (c–e) Distal to proximal colonoscopy images (sigmoid, descending colon and ascending colon).

Mantle cell lymphoma is a rare and aggressive form of B-cell non-Hodgkin lymphoma. Gastrointestinal involvement is one of the most common forms of extranodal involvement.^1,2 Such intestinal involvement may take the form of so-called “lymphomatoid polyposis”, which manifests as multiple sessile polypoid lesions and which requires histological study for its differential diagnosis with hamartomatous or adenomatous polyposis.^1,3,4