A case of colonic mantle cell lymphoma: new insights in a rare disease

Abstract

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.