Np. Breslin et al., Mucosa-associated lymphoid tissue (MALT) lymphoma manifesting as multiple lymphomatosis polyposis of the gastrointestinal tract, AM J GASTRO, 94(9), 1999, pp. 2540-2545
There have been a number of previous case reports of lymphomas in the form
of multiple mucosal polyps affecting variable lengths of colonic and intest
inal mucosa. Invariably these have been classified histologically as mantle
cell lymphomas. We report a case of this rare syndrome that illustrates ma
ny of its typical features but which demonstrates significant histological
and immunophenotypic differences. A 67-yr-old man was referred with a 3-mon
th history of altered bowel habit and a barium enema suggestive of extensiv
e ulcerative colitis. At colonoscopy, diffuse umbilicated mucosal polyps we
re seen throughout the colon and a larger circumferential mass lesion at th
e ileocecal valve. Biopsies demonstrated a diffuse B-cell lymphoma consiste
nt with "multiple lymphomatous polyposis" of the colon. Flow cytometry reve
aled CD25 positive/CD5 negative lymphoid cells confirming marginal B-cell l
ymphoma of mucosa-associated lymphoid tissue (MALT) type. Upper gastrointes
tinal investigations confirmed similar involvement of the stomach, duodenum
, and small bowel. Helicobacter pylori was absent. Flow cytometry abnormali
ties consistent with marrow involvement were present. These features led to
a diagnosis of stage IV marginal zone B-cell lymphoma of MALT type, presen
ting as multiple lymphomatous polyposis of the gastrointestinal tract. Thre
e months of combination chemotherapy resulted in an excellent symptomatic a
nd endoscopic response. (Am J Gastroenterol 1999;94:2540-2545, (C) 1999 by
Am. Coll. of Gastroenterology).