Multiple lyphomatous polyposis

About 30% of primary extranodal lymphomas occur in the gastrointestinal (GI) tract. Most of these are present as a single lesion, although about 10% exhibit GI polyposis, including multiple lymphomatous polyposis (MLP) and immunoproliferative small intestinal disease (IPSID). MLP is a rare intestinal malignancy characterized by the presence of numerous GI polypoid lesions of malignant lymphoma.

A 68-year-old man presented with history of abdominal pain, occult lower GI bleeding, loss of weight, sideropenic anemia and fever. Colonoscopy revealed a large number of different sized polyps. Abdominal ultrasound showed enlarged retroperitoneal lymph nodes. Chest and abdominal CT scan also demonstrated lymphoid dissemination. Gastroscopy and CT enteroclysis did not show polypoid lesions. Histopthological examination of large bowel polyps verified lymphocytes with irregular nucleuses. Immunohistochemistry (DAKO/LSAB+DAB) of tissue samples showed CD20, CD5, CD43, cyclinD1 positivity and CD79 alpha, CD3, cytokeratin negativity. Based on this data, a mantle cell lymphoma was diagnosed. The patient received CHOP+Mabthera (anti-CD20) protocol four times. The control colonoscopy showed disappearance of polyps.

In this case, we demonstrated a rare form of colonic polyposis. Combined chemotherapy was successful and the change of the endoscopic view was spectacular. In management of such rare cases we recommend a careful follow up of patients by gastroenterologists and oncologists. In case of relapse repeated chemotherapy or bone marrow transplantation is needed.