Multiple Primary Duodenal and Colonic Mantle Cell Lymphoma

A 62-year-old woman was referred for gastroscopy and colonoscopy due to chronic abdominal distension. Except for mild hypertension, her medical history was not relevant. The laboratory test results and abdominal examination were normal. Gastroscopy revealed an erosive lesion of duodenal bulb (Fig. 1A). Endoscopic ultrasonography showed the hypoechoic lesion locating in the submucosa layer (Fig. 1B). Colonoscopy showed multiple sessile polyps located throughout the transverse and sigmoid colon (Fig. 1C, D). Endoscopic submucosal dissection was performed to remove the nodules. Histopathology of the duodenal and colonic polyps revealed multiple lymphoid infiltrates (Fig. 2A, B). Immunohistochemistry of CD20, cyclin-D1, Bcl-2 and SOX11 expression was positive (Fig. 2C-F), which was consistent with mantle cell lymphoma. The bone marrow biopsy and positron emission tomography/computed tomography scan were negative for infiltration. The patient received 3 cycles of cyclophosphamide, vincristine, doxorubicin, prednisone, and rituximab. Mantle cell lymphoma is a subtype of B-cell non-Hodgkin lymphoma [1]. Duodenal and colonic mantle cell lymphomas are rare, commonly presents as multiple lymphomatous polyposis, characterized by nodular and polypoid lesions with segmental gastrointestinal tract distribution. [2] The expression of cyclin D1 characterized non–Hodgkin's lymphomas of mantle cell type. Clinical manifestations usually include abdominal pain, diarrhea, hematochezia, weight loss and fatigue [3]. Follow-up endoscopy after 6 months confirmed no recurrence for this patient.

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