THE CASE OF CARPETED POLYPS

Abstract

Mantle cell lymphoma (MCL) is a rare, distinct mature B-cell non-Hodgkins lymphoma. We present a case of MCL characterized by multiple large polyps carpeting the colon on endoscopy. Case Report: A 63-year-old white woman was referred for evaluation of intermittent epigastric pain unresponsive to H2RAs, intermittent constipation without relief with fiber and 25 lb weight loss. She had hypertension, hyperlipidemia and hypothyroidism. No FMH of malignancy. Her PE revealed splenomegaly, a non-tender mass in the mid-epigastric region and heme positive stools. Her WBC was 22,000 (66% lymphocytes) and hematocrit of 29.9%. EGD showed a 1.5 cm mass-like ulcer in the duodenal bulb. Colonoscopy revealed multiple polyps from rectum to transverse colon (Figure 1). Immunophenotype and immunostains from both the duodenal mass and colon polyps confirmed the diagnosis of MCL. Immunohistochemical stains were positive for CD20, CD5, cyclin D1 (Fig 2). CT revealed multiple abnormal soft tissue densities ranging from 2–7 cm in size scattered throughout the mesentery and the retroperitoneum. The patient completed 6 cycles of CHOP chemotherapy. She is now (2 years since diagnosis) in remission and doing well.FigureFigureDiscussion: MCL, also known as multiple lymphomatous polyposis (MLP), is an uncommon type of GI lymphoma involving mainly the colon and small intestine, but gastric and duodenal involvements have been reported. It occurs more commonly in men, mean age of 55 to 64. Abdominal pain, diarrhea, hematochezia, and palpable mass are common presenting manifestations. Systemic chemotherapy is the treatment of choice but MCL is presently considered incurable with a median survival of 3 to 5 years. [figure 1] [figure 2]