Mantle Cell Lymphoma Presenting Research Articles

Treatment Pattern and Survival Outcome of Limited Stage Mantle Cell Lymphoma: A National Cancer Database Analysis in Pre-BTK Inhibitor Vs BTK Inhibitor Era

Background Limited stage (stage I−II) disease is an uncommon presentation of mantle cell lymphoma (MCL), and its optimal management remains controversial. A British Columbia study (Leitch, Ann Oncol, 2003) and a Surveillance, Epidemiology and End Results (SEER) study (Murthy, Clin Lymphoma Myeloma Leuk, 2014) suggested the importance of radiotherapy (RT). A National Cancer Database (NCDB) study in the pre-BTK inhibitor (BTKi) era showed that chemotherapy (Chemo) plus RT (Chemo+RT) improved overall survival (OS) compared to Chemo or RT alone (Gill, Int J Radiat Oncol Biol Phys, 2015). However, a retrospective International Lymphoma Radiation Oncology Group study (Dabaja, Ann Oncol, 2017) reported comparable OS with Chemo+RT vs Chemo or RT alone. The potential differences in OS with different frontline therapy modalities may be modified by subsequent therapies for relapsed or refractory (R/R) disease. In this study, we used the NCDB data to analyze frontline treatment patterns and outcomes of limited stage MCL in the pre-BTKi vs BTKi eras. Methods The NCDB was queried to identify patients with stage I−II MCL diagnosed in 2004−2020. Because the first BTKi ibrutinib was approved by the FDA for R/R MCL in November 2013, we defined 2004−2013 as pre-BTKi era and 2014−2020 as BTKi era. Frontline treatment modalities were categorized to RT alone, Chemo alone, or Chemo+RT. Survival analysis was performed using the Kaplan-Meier method and the Cox proportional hazards model. Results Among 32,746 patients with newly diagnosed MCL in 2004−2020, 3,836 (11.7%) presented with stage I−II disease, with 2,428 having treatment information available. For patients diagnosed in the pre-BTKi era (n = 2005), 195 (9.7%) received RT alone, 1472 (73.4%) received Chemo alone, and 338 (16.9%) received Chemo+RT. For patients diagnosed in the BTKi era (n = 423), 45 (10.6%) received RT alone, 320 (75.7%) received Chemo alone, and 58 (13.7%) received Chemo+RT. Patients in the RT alone group were older (P <0.001) and had more females (P <0.001), but there were no statistically significant differences in Charlson-Deyo score, international prognostic index, or treating facility type (academic vs non-academic). For patients with stage I disease, in the pre-BTKi era, patients treated with Chemo+RT (n = 182) had improved OS compared to those treated with RT alone (n = 141) or Chemo alone (n = 647), with a 5-year OS of 75.4% vs 71.8% vs 61.4% (P <0.001). Similar results were observed in the BTKi-era, with a 5-year OS of 83.6% vs 69.5% vs 62.9% (P <0.001) for patients treated with Chemo+RT (n = 31), RT alone (n = 30), or Chemo alone (n = 130), respectively. After adjusting for age and sex, Chemo+RT was associated with improved OS compared to Chemo alone (pre-BTKi era, HR = 0.59, 95% CI = 0.46−0.75, P <0.001; BTKi era, HR = 0.34, 95% CI = 0.14−0.79, P = 0.013), but not compared to RT alone (pre-BTKi era, HR = 0.62, 95% CI = 0.23−1.68, P = 0.343; BTKi era, HR = 0.77, 95% CI = 0.56−1.05, P = 0.10) (Figure 1A). For patients with stage II disease, in the pre-BTKi era, patients treated with Chemo+RT (n = 156) had improved OS compared to those treated with RT alone (n = 54) or Chemo alone (n = 825), with a 5-year OS of 70.0% vs 47.3% vs 58.4% (P <0.001). In the BTKi-era, patients treated with Chemo+RT (n = 27) or RT alone (n = 15) both had improved OS compared to those treated with Chemo alone (n = 190), with a 5-year OS of 77.2% vs 78.8% vs 61.9% (P = 0.004) . After adjusting for age and sex, Chemo+RT was associated with improved OS compared to Chemo alone in BTKi era only (pre-BTKi era, HR = 0.85, 95% CI = 0.67−1.07, P = 0.165; BTKi era, HR = 0.49, 95% CI = 0.25−0.95, P = 0.034), but not compared to RT alone (pre-BTKi era, HR = 0.78, 95% CI = 0.53−1.13, P = 0.185; BTKi era, HR = 0.97, 95% CI = 0.35−2.67, P = 0.952) (Figure 1B). Conclusions Treatment pattern for limited stage MCL has not changed significantly from the pre-BTKi era to the BTKi era, with approximately 15% of patients receiving Chemo+RT, 10% RT alone and 75% Chemo alone. In the BTKi era, Chemo+RT appeared to be associated with better OS compared to Chemo alone but not compared to RT alone. Interpretation of the results requires caution because (1) patient numbers are small in Chemo+RT and RT alone groups, (2) longer follow-up may be needed, and (3) selection of therapy was not random, eg, patients receiving Chemo alone may have had higher disease burden such as bulky disease and/or non-contiguous stage II involvement but these details are not available in NCDB.

Mantle Cell Lymphoma Presenting as Erosive Duodenitis.

Mantle Cell Lymphoma Presenting as Erosive Duodenitis.

Unusual solitary rectal relapse of mantle cell lymphoma after second remission

Mantle cell lymphoma is a rare type of B cell non-Hodgkin's lymphoma (NHL) comprising only 3%–6% of all NHL. It is aggressive and prone to relapse. Around 15%–30% of the patients present with gastrointestinal tract involvement. Solitary rectal mantle cell lymphoma is rare and there are very few reports of the same. Till date, there is no report of a solitary rectal relapse of mantle cell lymphoma occurring after second remission. We report a relapse of solitary rectal mantle cell lymphoma presenting with rectal bleeding after second remission in primary gastric mantle cell lymphoma.

S3374 Asymptomatic Multiple Lymphomatous Polyposis: An Atypical Presentation of Mantle Cell Lymphoma

S3374 Asymptomatic Multiple Lymphomatous Polyposis: An Atypical Presentation of Mantle Cell Lymphoma

S2063 Mantle Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis of the Colon

Introduction: Mantle Cell Lymphoma (MCL), a type of non-Hodgkin lymphoma (NHL) is an aggressive neoplasm affecting the lymphatic system. Its incidence is 1–2 cases/105 people/year and accounts for only 5-6% of all cases of NHL. Multiple lymphomatous polyposis (MLP) is a rare presentation seen in MCL consisting of diffuse nodules or polyps covering multiple sites of the gastrointestinal tract. Case Description/Methods: A 68-year-old female with a past medical history of hypertension presented to the clinic with a one-year history of mild diffuse abdominal pain, change in bowel habits including loose stools, and significant involuntary weight loss. A review of systems, physical examination, and routine blood work was non-remarkable. The upper endoscopy was normal but a colonoscopy revealed numerous 1-10 mm submucosal nodules in the entire colon. Biopsies obtained from the nodules of the colon revealed colonic mucosa infiltrated with monotonous, small to medium-sized lymphocytes with irregular nuclear contour, and scant cytoplasm. Immunohistochemistry and immunophenotypic analysis were positive for CD20, CD5, Cyclin D1, BCL6, BCL 2, SOX 11, and negative for CD 10, and P 53. FISH testing revealed 11,14 translocations, consistent with Mantle Cell Lymphoma. CT scan of the abdomen showed pre-carinal, right hilar, extensive para-aortic, and mesenteric lymphadenopathy consistent with stage 4 Mantle Cell Lymphoma. She was subsequently started on Bendamustine and Rituximab combination therapy followed by Rituximab for maintenance. There was a significant improvement in her clinical status with progressive weight recovery. Follow-up upper and lower endoscopic examinations after 6 cycles revealed complete remission with the absence of all polypoid lesions in the GI tract (Figure 1). Discussion: The initial presentation of MCL can widely vary from being asymptomatic to having systemic symptoms of fever and weight loss to marked lymphadenopathy on physical examination. Although 15-30% of individuals with Mantle cell lymphoma (MCL) are reported with involvement in the gastrointestinal (GI) tract, MLP is seen only in less than 10%. It is important for clinicians to not only incorporate MCL as a differential in their workup when they come across diffuse polyps in the GI tract but also to differentiate it from other similar disease processes that present with multiple polyps in the colon. A definitive diagnosis of MLP requires biopsy and histological examination of the tissue with immunophenotypic and immunohistochemistry analysis.Figure 1.: Multiple sessile polypoid lesions of different sizes throughout the colon.

S2509 Mantle Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis: A Case Report

Introduction: Mantle Cell Lymphoma (MCL) typically presents with extensive lymphadenopathy, fevers, night sweats and unintentional weight loss. However, Multiple Lymphomatous Polyposis (MLP), MCL arising from the gastrointestinal tract, is an aggressive malignancy and is infrequently described. Case Description/Methods: A 68-year-old White man with atrial fibrillation and hypertension presented to the hospital with watery diarrhea, fatigue and intermittent epigastric pain for the past several weeks. He denied melena, hematochezia, heartburn, dysphagia, odynophagia, weight loss, loss of appetite, NSAID use, recent travel or sick contacts. There was no family history of gastrointestinal malignancy. No history of prior endoscopic evaluation. Physical exam was notable for brown stool on rectal exam. Further evaluation revealed Hgb 6.4, MCV 60.9, iron 43, TIBC 442 and iron saturation 10% consistent with iron deficiency anemia. Upper endoscopy was normal. Colonoscopy showed 8 6-16 mm polyps scattered throughout the colon, all of which were resected completely. Analysis showed a range of histology – 3 tubular adenomas, 1 serrated and 2 hyperplastic polyps. However, histology of 4 polypoid appearing lesions (Figure 1A) showed prominent nodular atypical submucosal lymphoid aggregates (Figure 1B) that were positive for CD20, cyclin D1, weak CD5, and negative for CD10 and CD23. This was consistent with the diagnosis of MCL. CT imaging showed diffuse lymphadenopathy, including bulky disease with a 16.6 x 10.6 cm small bowel mesenteric mass (Figure 1C), along with proximal small bowel and terminal ileal thickening. He was induced with 6 cycles of bendamustine-rituximab combination therapy and maintained on rituximab. A re-staging scan at 27 months showed no evidence of disease progression. Discussion: We present a case of MCL presenting as MLP with symptoms of anemia, diarrhea and epigastric pain. MCL is a rare B-cell non-Hodgkin's lymphoma that portends a poor prognosis, making early identification and diagnosis critical. Obstruction, GI bleeding, and perforation are common complications for MCL presenting as MLP. It is important to keep MLP on the differential when multiple small nodular or polypoid lesions are identified on colonoscopy. All different types of polyps should be resected or sampled during colonoscopy, and each evaluated by the pathologist to avoid missing clinically significant conditions. Early diagnosis is key to prevent morbidity and mortality in MLP as described in our case.Figure 1.: (A) polypoid lesion (B) nodular atypical submucosal lymphoid aggregates (C) 16.6 x 10.6 cm small bowel mesenteric mass.

Mantle cell lymphoma negative for t(11,14) involving the kidneys: a case report

BackgroundMantle cell lymphoma is the rarest subtype of non-Hodgkin’s lymphoma. It can exhibit diverse extranodal manifestations. However, renal involvement is uncommon, and if it occurs, it usually only gets detected postmortem. There are several mechanisms by which mantle cell lymphoma can damage the kidneys. Renal failure is a potential complication, and prompt evaluation and diagnosis are critical steps to prevent long-term complications.Case presentationWe present the case of a 75-year-old non-Hispanic White male with past medical history significant for hypertension and dyslipidemia, presenting with fever, weight loss, and night sweats. Work-up showed markedly elevated white blood cells, multiple enlarged lymph nodes, and a kidney mass. The patient was diagnosed with mantle cell lymphoma with kidney involvement confirmed with a kidney biopsy. His disease was positive for cyclin D1 overexpression despite t(11; 14) absence. The patient received six cycles of alternating vincristine, rituximab, cyclophosphamide, doxorubicin, and prednisone then dexamethasone, high-dose cytarabine, and oxaliplatin, after which he was maintained on ibrutinib and rituximab, with resolution of symptoms and disease regression.ConclusionWe present a case of a rare presentation of Mantle cell lymphoma while describing the clinical presentation and diagnostic and treatment approaches. This case report can assist physicians in the clinical work-up and treatment of patients with similar diagnosis or presentation.

Impact of Diagnosis-to-Treatment Interval on Overall Survival in Patients with Mantle Cell Lymphoma: A National Cancer Database Analysis

Impact of Diagnosis-to-Treatment Interval on Overall Survival in Patients with Mantle Cell Lymphoma: A National Cancer Database Analysis

S1784 Recurrent Mantle Cell Lymphoma Presenting as Colonic Intussusception

S1784 Recurrent Mantle Cell Lymphoma Presenting as Colonic Intussusception

Mantle Cell Lymphoma Presenting as Diarrhea in a Liver Transplant Recipient

ABSTRACTWe present a 63-year-old man with a medical history of hepatocellular carcinoma who underwent orthotopic liver transplant 10 years prior on long-term immunosuppressive therapy. The patient presented to the clinic with diarrhea, and the workup revealed mantle cell lymphoma. Mantle cell lymphoma is an extremely rare finding in transplanted livers. It is essential to include mantle cell lymphoma, along with a broad differential, during the workup of diarrhea in post-transplant patients.

Treatment patterns and outcomes of unfit and elderly patients with Mantle cell lymphoma unfit for standard immunochemotherapy: A UK and Ireland analysis.

Mantle cell lymphoma (MCL) presenting in elderly, unfit patients represents a clinical challenge. Front-line 'attenuated' or low-intensity immunochemotherapy is often employed, although outcomes are relatively unexplored. We report outcomes of attenuated immunochemotherapy in 95 patients with MCL across 19 centres in the UK and Ireland considered unfit for full-dose rituximab-bendamustine or rituximab-cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP). Regimens examined were rituximab-cyclophosphamide, vincristine, prednisolone (R-CVP) (n=19), dose-attenuated R-CHOP (n=22), dose attenuated rituximab-bendamustine (n=24) and rituximab-chlorambucil (n=30). The primary outcome was progression-free survival (PFS). The secondary outcomes included overall response, overall survival (OS) and toxicity. The median (range) age was 79 (58-89)years and 50% were aged ≥80years. The median (range) Cumulative Illness Rating Scale-Geriatric score was 6 (0-24). The median PFS for all patients was 15months [95% confidence interval (CI) 8·7-21·2) and median OS was 31·4months (95% CI 19·7-43·2). By multivariable analysis (MVA), the only clinical factor associated with an inferior PFS was blastoid morphology [hazard ratio (HR) 2·90, P=0·01). Notably, higher treatment intensity (R-CHOP/R-bendamustine composite) provided an independently superior PFS compared with R-CVP/R-chlorambucil (MVA HR 0·49, P=0·02). Factors associated with inferior OS by MVA were Eastern Cooperative Oncology Group Performance Status (HR 2·14, P=0·04), blastoid morphology (HR 4·08, P=0·001) and progression of disease at <24months status (HR 5·68, P<0·001). Overall, survival after front-line dose-attenuated immunochemotherapy is unsatisfactory. Clinical trials investigating novel agents such as Bruton tyrosine kinase and B-cell lymphoma 2 inhibitors in this specific clinical setting are warranted.

Renal Involvement as Initial Presentation of Mantle Cell Lymphoma: A Case Series

Renal Involvement as Initial Presentation of Mantle Cell Lymphoma: A Case Series

S1704 Mantle Cell Lymphoma Presenting as Colonic Polypoid Nodules in a Crohn’s Disease Patient With History of Azathioprine Use

INTRODUCTION: The gastrointestinal (GI) tract is the most common extra nodal site affected by lymphoma, accounting for 5–20% of all cases. Of all GI lymphoma subtypes, mantle cell lymphoma (MCL) is more frequently noted in the ileum and colon. We present a case of MCL presenting as mucosal polypoid nodules in a Crohn's disease patient with history of azathioprine use. CASE DESCRIPTION/METHODS: A 71-year- old male presented to the clinic for management of Crohn’s disease (CD). He was diagnosed at the age of 25 when he developed acute small bowel obstruction secondary to a terminal ileum (TI) stricture and required resection and ileo-colonic anastomosis. He had treatment failure with infliximab due to antibody formation and was managed with azathioprine for over 30 years. Surveillance colonoscopy a year ago showed active ileo-colonic disease and ustekinumab was initiated. Past medical history was remarkable for generalized lymphadenopathy involving the supraclavicular, mediastinal and mesenteric regions. Previously, patient had undergone an excisional lymph node biopsy that was negative for lymphoma. Laboratory testing showed leukocyte count of 5.5 × 109/L with normal differential, hemoglobin of 14.1 g/dL, and a platelet count of 106 L K/uL. Colonoscopy showed scattered erosions and friable mucosa in the entire examined colon and TI. Interestingly, a 2 cm submucosal nodule was noted in the proximal colon that appeared to be a lipoma with mucosal inflammation. Similar small submucosal nodules were noted in the rectum and biopsies were obtained. Pathology of the biopsied nodules revealed atypical lymphoid proliferation. On immunohistochemical staining, B cells were identified, positive for CD 20, CD5, BCL-1, BCL-2, CD43 but negative for CD10 and CD23. The findings were consistent with mantle cell lymphoma. PET scan and bone marrow biopsy revealed disseminated disease with bone marrow involvement. The patient’s immunosuppression was discontinued, and he was referred to oncology for chemotherapy. DISCUSSION: MCL is an aggressive subtypes of B-cell non-Hodgkin lymphoma and most patients have advanced-stage disease at diagnosis. Patients with MCL and GI involvement could be asymptomatic or may present with abdominal pain, obstruction, diarrhea, or overt bleeding. Endoscopic findings may include normal mucosa, nodules, polyps, ulcers, and masses. It is important to biopsy seemingly benign lesions as in our case, if index of suspicion is high. Further history of azathioprine is known to increase lymphoma risk.Figure 1.: A 2 cm smooth submucosal nodule with erythematous mucosal changes noted in the proximal colon.

Secondary Postpartum Haemorrhage: A Rare Presentation of Secondary Uterine Mantle Cell Lymphoma

Postpartum haemorrhage (PPH) is rarely the initial presentation of a disseminated non-Hodgkin lymphoma (NHL). Herein, we describe the very first case of a uterine mantle cell lymphoma (MCL) presenting with PPH. A 30-year-old P1L1 female patient presented with secondary PPH following an emergency caesarean section. Ultrasonogram revealed a hypo-echoic mass in the uterine cavity, histopathological examination of which revealed MCL. Metastatic evaluation of the patient showed a widespread disease with skeletal and lymph node involvement. She was staged Ann Arbor IV NHL with International Prognostic Index (IPI) of 2/5. Despite chemoradiation, she succumbed to leptomeningeal spread and expired 5 months from diagnosis. The involvement of female genital organs by malignant lymphomas is a rare but possible scenario with perilous outcomes. The unusual clinical presentations necessitate a high degree of suspicion with prompt pathological confirmation and individualised therapy.

Mantle Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis of the Colon

AbstractMantle cell lymphoma (MCL) is a subset of B-cell non-Hodgkin’s lymphoma with a tendency to involve the gastrointestinal (GI) tract and presents as multiple lymphomatous polyposis of one or multiple segments of the GI tract. Here, we report an unusual case of a 58-year-old female presenting with chief complaints of constipation, bleed per rectum, and unintentional weight loss of 15 kg over 6 months. Colonoscopy revealed the entire colon to be studded with polypoidal lesions of varying sizes which were biopsied. Histopathological examination and immunohistochemistry confirmed the polypoidal lesions to represent MCL. Computed tomography scan showed numerous variable-sized polypoidal lesions scattered throughout the entire colon along with paraaortic and mesenteric lymphadenopathy. Thus far, she has undergone three cycles of chemotherapy with R-CHOP resulting in significant tumor reduction and symptomatic improvement in her well-being.

Mantle cell lymphoma presenting as synchronous bilateral breast lumps and arm mass.

Mantle cell lymphoma presenting as synchronous bilateral breast lumps and arm mass.

1602 Mantle Cell Lymphoma Presenting as Intussuscepting Colon Mass

INTRODUCTION: Mantle Cell Lymphoma (MCL) is a non-Hodgkin lymphoma accounting for 2.5% of lymphoid neoplasms in the United States. Primary gastrointestinal (GI) lymphomas account for 1-4% of all GI malignancies, with few reports of primary mantle cell lymphoma presenting as a single colonic mass and none to our knowledge with colon-colonic intussusception as the presenting finding. Accurate and timely diagnosis is imperative because MCL has rapid progression and early chemotherapeutic intervention results in improved patient outcomes. CASE DESCRIPTION/METHODS: A 61-year-old male presented with 1 month history of nonspecific right sided abdominal pain. Computed Tomography (CT) of the abdomen identified an intussuscepting mass of the proximal ascending colon and an additional 8mm hepatic lesion. Colonoscopy identified a large mass in the corresponding area of colon identified on CT. Histology and immunohistochemistry of biopsied specimen diagnosed MCL. Planned surgical intervention was deferred and the patient was referred for oncologic evaluation and treatment. DISCUSSION: We report the first case to our knowledge of MCL presenting as colon-colonic intussusception and discuss the work-up of this rare lymphoma that clinicians may be required to diagnose and manage. This report serves as a reminder to maintain a broad differential inclusive of uncommon diseases and unanticipated pathology. Practicing with a thorough understanding of medical principles and clinical acumen is essential for optimal patient care and, as demonstrated in this case, preventing a potentially unnecessary surgical intervention thus delaying appropriate chemotherapy.

1267 Recurrent Mantle Cell Lymphoma to the Gall Bladder: A Peculiar PET CT

INTRODUCTION: Mantle Cell Lymphoma (MCL) is a B-cell non-Hodgkin lymphoma that has a variable course. The initial presentation of MCL is usually nonspecific and varies based on the organ involved. Initial treatment includes a variety of chemotherapeutic options; however, almost all patients will have refractory or recurrent disease due to the rapid development of chemotherapy resistance. In this case report, we present a rare presentation of recurrent mantle cell lymphoma in the gall bladder. CASE DESCRIPTION/METHODS: Our patient is a 61-year-old female with history of mantle cell lymphoma diagnosed in 2008. At that time patient was treated with Rituxan/hyper-CVAD with an excellent response to treatment. Patient had a disease recurrence in 2012 on axillary lymph node biopsy and received 6 cycles of Bendamustine and Rituximab and achieved remission as determine by PET CT. The patient decided against allogeneic hematopoietic stem cell transplant (HCT) and was started on Rituximab maintenance therapy by 2013. Patient had another recurrence on axillary lymph node biopsy in 2017 and was placed on Ibrutinib with no FDG noted on subsequent PET-CTs in 2/2018 and 5/2018. A surveillance PET CT performed in 12/2018 showed intense avid FDG uptake involving the gallbladder (Figure 1). A MRI was performed that showed an enhancing lesion in the dorsal aspect of the descending duodenum measuring 18 mm. Upper endoscopy revealed a prominent fold with biopsies taken with no histopathologic abnormality. The patient was subsequently taken for uncomplicated cholecystectomy with one lymph node associated and sent for pathology. Pathology results showed the cystic duct lymph node and gallbladder wall involved by MCL with 40 mitoses per 15HPF and Ki-67 proliferative index of 34% (Figures 2 and 3). This suggested a more aggressive MCL. The patient was started on Revlimid and Rituximab, and will be awaiting clinical trial eligibility at a nearby facility. DISCUSSION: MCL typically follows an aggressive clinical course with high risk of recurrence regardless of chemotherapeutic regimen. One previous case with MCL to the gallbladder was found incidentally as a lymphomatous polyp. An additional case presented with intussception with a mass noted during surgical repair. Overall, there have been approximately 66 cases of B-cell lymphoma noted to the gallbladder, and two prior cases as above of MCL. Our case represents a rare presentation of relapsed MCL to the gall bladder and the wide possibility of metastasis associated with recurrent MCL.

1913 A Unique Presentation of Asymptomatic Mantle Cell Lymphoma at Screening Colonoscopy: Beware of a Lumpy-bumpy Mucosa

INTRODUCTION: Mantle cell lymphoma (MCL) is a rare aggressive subtype of non-Hodgkin’s lymphoma. Most cases of MCL initially present with diffuse lymphadenopathy. The gastrointestinal (GI) tract is involved in 15–30% of cases and can manifest as a rare clinical entity called multiple lymphomatous polyposis (MLP). Because of its rarity, a clinical syndrome of MLP is not well defined and its presentation varies. Prior case reports describe the presence of GI symptoms in patients with MLP. We present an unusual case of an asymptomatic patient who was found to have MLP on screening colonoscopy and subsequently diagnosed with MCL. CASE DESCRIPTION/METHODS: A 55 year-old female presented for a screening colonoscopy with a family history of colon cancer. Her last screening colonoscopy 5 years prior was unremarkable. She denied any change in bowel movement, blood in her stool, abdominal pain, chest pain, or shortness of breath. Her CBC and CMP one year prior were unremarkable. At colonoscopy numerous small nodular, submucosal polypoid lesions with a prominent vascular pattern were found in the terminal ileum; the mucosa of sigmoid, descending, transverse, and ascending colon had a diffuse subtle nodular appearance. With narrow band imaging, numerous &lt;1 mm nodules with atypical vascular pattern were visualized. Biopsies of all lesions were obtained for histology and flow cytometry, which confirmed a diagnosis of mantle cell lymphoma. Subsequent laboratory evaluation revealed a normal CBC and BMP, mildly elevated AST and ALT to 40–50s U/L, and an elevated LDH of 400 U/L. PET CT scan demonstrated left cervical lymphadenopathy (up to 1.9 cm), mesenteric lymphadenopathy (up to 1.2 cm), and uptake at the ileocecal junction. She was begun on a regimen of rituximab, cytarabine, and bendamustine by oncology. DISCUSSION: This case illustrates an unusual presentation of MLP in that it was discovered in an asymptomatic at time of her screening colonoscopy. It is important to recognize this rare endoscopic entity as early diagnosis and treatment improve the prognosis. The diagnosis of MLP should be considered whenever multiple submucosal polypoid lesions are encountered during endoscopy. Histopathology and flow cytometry are key to confirming the diagnosis; therefore, it is important to submit representative biopsies of these lesions for both histology and cytology to avoid delay in diagnosis, need for repeat procedures, and delay in treatment.

Myasthenia Gravis Associated With Orbital Marginal Zone Lymphoma

Myasthenia Gravis Associated With Orbital Marginal Zone Lymphoma