Multiple lymphomatous polyposis of the gastrointestinal tract

Abstract

CONTEXT: Gastrointestinal multiple lymphomatous polyposis is a rare type of malignant lymphoma that has aggressive biological behavior, early systemic dissemination and poor prognosis. It is considered to be a manifestation of non-Hodgkin lymphoma and represents the gastrointestinal counterpart of mantle cell nodal lymphoma. OBJECTIVE: A case of gastrointestinal multiple lymphomatous polyposis is presented and the anatomopathological, clinical, diagnostic and treatment aspects of this unusual neoplasia are discussed. CASE REPORT: The patient was a 59-year-old white male with a complaint of asthenia, night sweating, alteration in intestinal habit and weight loss over the preceding two months. The physical examination showed pallid mucosa and a palpable mass in the epigastrium and mesogastrium. Endoscopy of the upper digestive tract showed the presence of gastric and duodenal polyps. An opaque enema showed multiple polypoid lesions, especially in the cecum. A rectal biopsy revealed infiltration of the mucosa and submucosa by diffuse lymphoma consisting of small cleaved cells. Immunohistochemical study showed lymphocytes that expressed the antibody CD20 (L-26) and light-chain kappa (k) immunoglobulin, but not light-chain lambda (l) immunoglobulin. The patient presented a condition of acute intestinal obstruction with the presence of a mesenteric mass formed by agglutinated lymph nodes that surrounded the proximal ileum, thereby obstructing its lumen. He was submitted to a segmental enterectomy and gastrotomy with excisional biopsies of the gastric polypoid lesions. After two cycles of chemotherapy there was a worsening of the general state, with an increase in the dimensions of the abdominal masses and sepsis, accompanied by progressive respiratory insufficiency, leading to death.

Extensive colorectal lymphomatous polyposis complicated by acute intestinal obstruction: a case report

“…In general, patients with MLP have no specific clinical manifestations, but the most frequent symptoms are abdominal pain, diarrhea, palpable masses, melena, hematochezia, weight loss, and fatigue [2, 9, 18]. The patient in this study complained of fatigue, diarrhea, abdominal pain, and weight loss, but not of palpable masses or GI bleeding.…”

Primary intestinal diffuse large B-cell lymphoma forming multiple lymphomatous polyposis

“…Treatment approaches are similar to those for high-grade aggressive lymphomas, and in addition to surgery, various chemotherapy regimens are administered. The mean survival rate has been reported to be approximately 20-30 months after initial diagnosis (2,4,11,12,20).…”

“…First described by Cornes in 1961, this developmental pattern accounts for 1-2% of GIS lymphomas (1,4,8,(10)(11)(12). MLP is thought to represent mantle cell lymphoma of the GI tract (13,(16)(17)(18)(19).…”

“…tity defined as multiple lymphomatous polyposis (MLP), which is characterized by multiple polypoid lesions affecting the same or different GIS segments, and it is a quite rarely encountered developmental pattern (1,4,(8)(9)(10)(11)(12)(13)(14)(15). First described by Cornes in 1961, this developmental pattern accounts for 1-2% of GIS lymphomas (1,4,8,(10)(11)(12).…”

Poliposis linfomatosa múltiple, evolución favorable tras tratamiento quimioterapéutico

“…La PLM afecta en la mayoría de los casos a varones en la quinta a la sexta década de la vida. En el 90% de los casos, los pacientes tienen Poliposis linfomatosa múltiple, evolución favorable tras tratamiento quimioterapéutico manifestaciones clínicas, las más frecuentes son diarrea, dolor abdominal y masa abdominal palpable (48%) 5,6 . Otros síntomas pueden ser anemia, pérdida de peso, fiebre, astenia y letargia.…”