Abstract
The identical twin sisters had rectal bleeding due to multiple polypoid lesions in their colon. Histologic findings were identical and showed the lesions were located in the submucosa and were made up of lymphoid tissue with follicle formation. The enlarged germinal centers were occupied by numerous large atypical lymphocytes and small population of small mature lymphocytes and scattered tingible body macrophages. The large atypical lymphocytes were positive for CD20. The small lymphocytes were positive for CD3 and CD5. Bcl-2 was positive in the mantle zone alone. Both large and small lymphocytes lacked kappa and lambda immunoglobulin light chain expression and cyclin D1. The marked cytological atypia and high proliferative index of large atypical lymphocytes mimicked malignant lymphoma. Immunoglobulin heavy chain gene rearrangement assay did not reveal a monoclonal rearrangement. Immunohistochemical profile and molecular analysis confirmed the diagnosis of lymphoid polyposis, an entity which had not been previously reported in identical twins.
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