A Unique Presentation of Primary Intestinal MALT Lymphoma as Multiple Lymphomatous Polyposis

Abstract

A 68-year-old male was admitted to Surgery department of the college with complaints of easy fatigability, pain abdomen & diarrhea since one year. He also complained of blood in stool, on and off, for last three months. His general physical and systemic examination & laboratory findings were normal except for an elevated ESR (=90 mm at the end of first hour) and anemia (hemoglobin 9.5 gm %). Chest X -ray was within normal limits. Colonoscopic biopsy was done at a different clinic, six months prior to his admission, and the microscopic examination showed "ulcerated colonic mucosa with granulation tissue, heavy mononuclear cell infiltrate and no evidence of malignancy." Subsequently, computer tomography of the abdomen was advised. It revealed circumferential wall thickening with intramural mass involving caecum & ascending colon along with multiple enlarged pericolonic lymph nodes. There was no hepatosplenomegaly. A provisional diagnosis of colonic carcinoma was made and the patient underwent right hemicolectomy.The resected specimen received in our pathology department was that of a colonic segment measuring 45cms in length, with the mucosal aspect being studded with a multitude of sessile polyps of varying sizes, largest measuring 3.5 x 2.5 x 1.8 cm [ ABSTRACTMultiple lymphomatous polyposis is considered to be a rare condition, with most of the cases being extranodal counterpart of mantle cell lymphomas. We report a rare case of multiple lymphomatous polyposis of the gastrointestinal tract in which the patient presented with abdominal pain and bloody diarrhea. Computer tomography of the abdomen showed circumferential wall thickening with intramural mass involving caecum & ascending colon with enlarged pericolonic lymph nodes. The patient underwent right hemicolectomy.Immunohistologic findings were characteristic of MALT lymphoma. Microscopic examination of polypoidal masses and mesenteric lymph nodes revealed infiltration by pleomorphic, atypical lymphoid cells which were CD20 positive and negative for CD3, CD10, Cyclin D1. Lymphoepithelial lesions were also noted. Careful endoscopic evaluation and histopathological review along with an immunohistochemical panel is extremely useful for accurately diagnosing such cases and avoiding unnecessary surgery and inappropriate therapy.

Synchronous colonic adenoma and intestinal marginal zone B-cell lymphoma associated with Crohn’s disease: a case report and literature review

“…MALT lymphoma is an extranodal lymphoma characterized by heterogenous small B-cells proliferation [18]. Stomach is the commonest site, while Colonic MALT lymphomas are exceedingly rare.…”

Mass-forming mucosa-associated lymphoid tissue lymphoma of the cecum treated by laparoscopy-assisted bowel resection

“…Surgical resection has been performed only in limited cases in previous reports, such as those with large tumors or those that were clearly symptomatic. However, they did not develop any recurrence within the described duration (Table 1) [3,4,[14][15][16][17][18][19]. Our case was colonic MALT lymphoma localized in the cecum and it was causing abdominal pain, so we performed ileocecal resection as a first treatment.…”