Duodenal involvement of mantle cell lymphoma observed by magnified endoscopy with narrow-band imaging

Abstract

A 67-year-old man with mantle cell lymphoma (MCL) in remission for 3 years underwent follow-up positron emission tomography-computed tomography that showed cervical and abdominal lymph node enlargement. EGD was performed, and on duodenoscopy, multiple polypoid lesions of varying sizes were observed (A). Magnified chromoendoscopy with crystal violet staining of the smaller lesions showed a concentric circled structure and dilatation of the surrounding villi (B), and narrow-band imaging revealed looped and elongated microvessels on the surface of the lesions (C). The same endoscopic findings were emphasized on the surface of the larger lesions (D). Endoscopic biopsy specimens taken from the small lesions showed infiltration of neoplastic lymphoid cells (E), which were positive for CyclinD1 (F), CD20, and Bcl-1 but negative for CD3, CD5, and CD10. The patient received a diagnosis of MCL involving the duodenum, and chemotherapy with bendamustine was begun.