Colonic lymphomatous polyposis

Abstract

A 58-year-old woman presented with diarrhea and lower abdominal pain of 2 weeks' duration. On examination, bilateral cervical and axillary lymph node enlargement was noted but not hepatosplenomegaly. The white blood cell count was 6600/mm3 (normal: 3500-8000/mm3), with a normal differential. Serum lactate dehydrogenase and calcium were within normal ranges. A test for serum antihuman T-lymphotropic virus type 1 (HTLV-1) antibody was positive. CT demonstrated enlargement of intra-abdominal lymph nodes. Evaluation of a cervical lymph node biopsy specimen revealed a diffuse infiltrate of abnormal lymphocytes, which contained multilobulated nuclei with condensed chromatin and agranular and basophilic cytoplasm. Monoclonal integration of HTLV-1 provirus in chromosomal DNA also was demonstrated. At colonoscopy, multiple polyps with a central depression were present throughout the colon (A), and biopsy specimens from these lesions consisted of a diffuse proliferation of abnormal appearing lymphocytes with hyperchromatic and highly convoluted nuclei (B; H&E, orig. mag. ×400). Immunohistochemically, these neoplastic cells were negative for the B-cell markers CD20 and CD79a, but positive for the T-cell markers CD3 and UCHL-1 (C; immunohistochemical stain, orig. mag. ×400). No abnormality was found by upper endoscopy or by barium contrast radiography of the small intestine. Thus, a diagnosis of a lymphoma subtype of adult T-cell leukemia/lymphoma with colonic involvement resembling multiple lymphomatous polyposis was established. The patient was treated with vindesine, cyclophosphamide, and doxorubicin but died 7 months after commencement of treatment.