Multiple Lymphomatous Polyposis Presenting with Lower Gastointestinal Bleeding

Abstract

Multiple lymphomatous polyposis is an uncommon disease, which is considered to be an intestinal form of mantle cell lymphoma. We present a case of a 66-year-old African American female who was admitted with a 1-week history of painless hematochezia. She has a history of mantle cell lymphoma that was diagnosed from an axillary lymph node biopsy on a prior admission. She refused chemotherapy at that time and was lost to follow up. On this admission she was initially orthostatic and had a hematocrit of 19. Physical examination was pertinent for mandibular, axillary and inguinal lymphadenopathy and rectal examination revealed dark red blood. NG lavage was clear. After resuscitation, she underwent a colonoscopy, which showed multiple polyps throughout the colon, ranging in size from 3 mm to 5cm. There were no rectal polyps. Some of the larger polyps were friable and oozing blood. There was a moderate amount of fresh blood mixed with clots in the lumen up to the transverse colon. Pathology showed diffuse infiltration of the lamnia propria by a monotonous population of atypical lymphocytes that was consistent with mantle cell lymphoma. In addition to the colonic polyps, CT abdomen also showed enlarged mesenteric and retroperitoneal lymph nodes. The liver, spleen and stomach appeared normal. The patient subsequently underwent a subtotal colectomy with ileo-rectal anastomosis for ongoing bleeding. There were innumerable colonic polyps many of which were hemorrhagic. The small bowel was inspected intra-operatively and found to have no lesions. The uninvolved colonic mucosa was unremarkable. The patient recovered uneventfully and was discharged with follow up in oncology clinic after she agreed to chemotherapy. [figure 1]Figure