An 82-year-old man was referred to our outpatient clinic because of
a change in bowel habits and involuntary weight loss. His medical history
consisted of atrial fibrillation. A few weeks before presentation he had
suffered a varicella zoster infection of his face. A colonoscopy was performed
to rule out colorectal carcinoma. Dozens of small sessile polyps, varying in
size, were found in the entire colon ([Fig. 1]).
The mucosa in the rectosigmoid region was diffusely swollen and polypous with
multiple superficial ulcerations ([Fig. 2]).
Biopsies of proximal and distal lesions revealed a mononuclear infiltration
between muscularis mucosae and otherwise normal-appearing crypts. Lymphocytes
showed nuclear irregularity. Immunohistochemistry showed positivity for CD5,
CD20, CD43, CD79a, Bcl-2, and cyclin-D1 ([Fig. 3]). Stainings for CD10, CD15, CD30, CD138, IgA,
IgG, and IgM were negative. This profile supports the diagnosis of a mantle
cell lymphoma (MCL). Unfortunately, the patient suffered an ischemic
cerebrovascular accident (CVA) the day after colonoscopy, 6 days after stopping
anticoagulants temporarily, leaving him hemiplegic and bedridden. For this
reason, it was decided to refrain from starting systemic chemotherapy. His
recent varicella zoster infection was considered a paraneoplastic phenomenon.
The patient died 6 weeks after diagnosis of complications of his CVA.
Fig. 1 Proximal colon.
Fig. 2 Rectosigmoid region.
Fig. 3 Histology showing
positivity for cyclin-D1 (× 400).
MCL is a non-Hodgkin’s B-cell lymphoma. The reported frequency
of gastrointestinal tract involvement in patients with MCL is
15 % – 30 % [1]. However, this is most likely an underestimate because
most patients with MCL involving the gastrointestinal tract previously reported
were examined endoscopically only if they had gastrointestinal symptoms
[2]. Systemic chemotherapy is the mainstay of treatment,
usually consisting of cyclophosphamide, adriamycin, vincristine, and prednisone
(CHOP) plus rituximab. More aggressive treatment regimens have been proposed
but according to recent data do not increase survival [3]. Median overall survival after diagnosis is 7 years.
Endoscopy_UCTN_Code_CCL_1AD_2AC
