A 67-year-old man had a surgical consultation due to presenting with anorexia, meteorism, and alternating bowel habits (diarrhea-predominant) that had started 3 months before. He did not complain of fever, weight loss, or abdominal pain. His past medical history was significant for appendectomy. A colonoscopy revealed multiple small (<1cm) non-ulcerated polypoid lesions –lymphomatous polyposis– extending from the ileocecal valve to the cecum (Fig. 1). The polyps were sessile, diminutive, and regular-shaped. The remaining colonic mucosa was unremarkable. Biopsies of the aforementioned polyps revealed small atypical lymphocytes and rare macrophages. Immunophenotypic analysis showed CD20, BCL2, BCL6, CD5, and cyclin D1 expression (Fig. 2). A positron emission tomography scan was positive for disseminated nodal involvement. Stage IV-A mantle cell lymphoma was diagnosed. The patient was started on rituximab and bendamustine, achieving remission. Mantle cell lymphoma is a subtype of B-cell non-Hodgkin lymphoma that commonly affects the gastrointestinal tract, particularly the ileocecal region.1 Approximately 10% present as lymphomatous intestinal polyposis that may resemble polypoid syndromes on endoscopy.2 The tumor is chemo-responsive. Most cases present at an advanced stage and the 5-year survival rate is 60%.3

Figure 1.

Cecal lymphomatous polyposis in white-light endoscopy.

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Figure 2.

Population of small lymphoid cells (×100) (left side) and cyclin D1 immunostaining showing nuclear expression in the cells (×100) (right side).

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