Romanian Journal of Gastroenterology September 2005 Vol.14 No.3, 273-278 Address for correspondence: Marcel Tanþãu, MD 3rd Medical Clinic Croitorilor Str. no.19-21 400162, Cluj-Napoca, Romania Gastrointestinal Lymphomatous Polyposis - Clinical, Endoscopical and Evolution Features. A Case Report Marcel Tanþãu 1 , Alina Tanþãu 1 , Teodor Zaharia 1 , Andrei Cucuianu 2 1) 3 rd Medical Clinic, University of Medicine and Pharmacy. 2) Haematology Clinic, Institute of Oncology, Cluj-Napoca Abstract Primary gastrointestinal non-Hodgkin lymphoma ac- counts for 13-18% of all malignant tumours of small bowel and only 1 % of large bowel tumours (1). Multiple lymphomatous polyposis is a rare entity, characterized by the presence of multiple lymphomatous polyps along the gut (2). Majority of cases with gastrointestinal primary lymphoma are classified histologicallly as “mantle cell” lymphomas. A 59 year old patient was admitted to our clinic for fatigue and rectal bleeding. Endoscopic examination of the colon revealed an infiltrative-exulcerative lesion of the terminal ileon, a polypoid mass on ileocecal valve and multiple polyps over the entire colon and rectum. Gastroscopy revealed polyps into the duodenal bulb. Histopathological and immunohistochemical studies on biopsy specimens from colon and duodenum confirmed gastrointestinal non- Hodgkin lymphoma, probably “mantle cell” lymphoma. Because she was in an advanced stage she received only cytostatic treatment. A clinical, endoscopical and histo- phatological follow up at 3, 6 and 12 months was performed. Key words Gastrointestinal tract - lymphomatous polyposis - im- munohistochemistry - mantle cell lymphoma Rezumat Limfomul non-Hodgkin primar gastrointestinal constituie aproximativ 13-18% din totalul tumorilor maligne ale intestinului subþire ºi doar 1% din cele ale colonului (1). Polipoza limfomatoasã multiplã este o entitate rarã ce se caracterizeazã prin apariþia mai multor tumori polipoide ce afecteazã diverse segmente ale tractului gastrointestinal (2). Majoritatea cazurilor de polipozã limfomatoasã gastro- intestinalã sunt histopatologic clasificate ca limfoame cu celule “în manta”. O pacientã de 59 ani a fost internatã în clinica noastrã pentru astenie ºi rectoragii. Colonoscopia a evidenþiat multiplii polipi rectali, colonici ºi pe valva ileo-cecalã, iar la nivelul ileonului terminal o formaþiune infiltrativ-exulceratã. Bulbul duodenal a fost investigat prin gastroduodeno- scopie, la acest nivel gãsindu-se câþiva polipi. Examinarea histologicã ºi imunohistochimicã efectuatã pe biopsiile din colon ºi duoden au stabilit diagnosticul de limfom non- Hodgkin gastrointestinal cu celule B, probabil varianta în manta. Având in vedere stadiul avansat de boalã pacienta a urmat doar tratament chimioterapic. S- a urmãrit evoluþia la 3, 6 ºi 12 luni de la diagnostic atât clinic cât ºi endoscopic ºi histopatologic. Introduction Primary gastrointestinal lymphoma represents about 4% to 20% of non-Hodgkin lymphomas. The ileocecal valve is the most frequently involved (35.8%), followed by the small bowel (31.3%), large bowel (19.4%) and multiple gastrointestinal involvement (13.4%) (3). In 1961, Cornes described for the first time the multiple lymphomatous polyposis and in 1984 Isaacson et al described the mantle cell form of the neoplasic lymphoid infiltration (2). Mantle cell lymphoma is a clinicopathologic entity with distinctive morphologic and immunophenotypic features and a characteristic cytogenetic abnormality, the t(11;14)(q13;q32) (4). Most mantle cell lymphomas occur in eldery patients, usually over 40 years (5). An accurate diagnosis is very important, since this tumor generally carries a poor prognosis and requires an aggressive treatment (4). We report the case of a 59-year-old woman presenting fatigue and rectal bleeding, in whom colonoscopy revealed multiple polyps on the entire large bowel and rectum and duodenoscopy showed a few polyps in the duodenal bulb.
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