Unusual Presentation of Mantle Cell Lymphoma of Gastrointestinal Tract

Abstract

Purpose: A 65 year old man presented to the hospital because of abdominal pain. The patient developed abdominal pain two days prior to presentation, most severe in right lower quadrant which was intermittent, spasmodic and non radiating in nature. The patient also had night sweats, weight loss of about 15 pounds associated with loose stools over last 3 months. The abdominal examination revealed mild tenderness in the right lower quadrant but no organomegaly and guarding. Computed tomography (CT) of the abdomen revealed mesenteric lymphadenopathy and radiological findings suggestive of Ileo colonic intussusception. Subsequently, a colonoscopy done showed a diffuse area of severely nodular mucosa in the entire colon and a small bowel lesion appeared to be causing intussusception of the ileum into the ascending colon (Figure). Biopsy of this mass showed immuno phenotypic features consistent with CD5-negative mantle cell lymphoma. He was treated With Rituximab and hyper CVAD (cyclophosphamide, vincristine, doxorubicin and dexamethasone) for eight cycles alternating with a cycle of methotrexate and Cytarabine. CT abdomen and pelvis done at six weeks confirmed resolution of the entire disease and a colonoscopy at eight weeks showed normal appearing ileum. Discussion: Involvement of the gastrointestinal tract in MCL is seen up to 20% to 30% of the cases. MCL can involve any region of the gastrointestinal tract. The most commonly seen endoscopic finding of mantle cell lymphoma involving the gastrointestinal tract is “multiple lymphomatous polyposis”, characterized by multiple polypoid lesions involving the gastrointestinal tract. This case presents with a rare complication that occurred secondary to mantle cell lymphoma involving the gastrointestinal tract. So far, a very few cases of mantle cell lymphoma presenting with intussusception have been reported.Figure: Ileo colonic intussusception.