title: Frequency of gastrointestinal involvement and its clinical significance in mantle cell lymphoma.
abstract: BACKGROUND
  The reported frequency of gastrointestinal (GI) tract involvement in patients with mantle cell lymphoma (MCL) is 15-30%. However, this figure most likely is an underestimate because most patients with MCL involving the GI tract previously reported were examined endoscopically only if they had GI tract symptoms. The impact of endoscopic assessment on the management of MCL patients is unknown.
  
  
  METHODS
  From March 1998 to May 2001 baseline upper and lower endoscopy of the GI tract was performed in consecutive untreated patients with MCL as part of a prospective therapeutic trial. Biopsies were performed on abnormal as well as macroscopically normal mucosa. Endoscopy was repeated during treatment and as part of follow-up evaluations.
  
  
  RESULTS
  Only 26% of patients presented with GI symptoms at the time of diagnosis. MCL was present histologically in the lower GI tract of 53 of 60 patient (88%) and in the upper GI tract of 28 of 58 patients (43%). Microscopic evidence of MCL was found in 84% of patients with normal visual (macroscopic) findings by lower endoscopy and in 45% of patients with macroscopically normal findings by upper endoscopy. Despite this high frequency of GI tract involvement, the use of upper and lower endoscopy with biopsies in this group of patients resulted in changes in clinical management in only three (4%) patients.
  
  
  CONCLUSIONS
  Gastrointestinal tract involvement was found to be present in most patients with MCL, usually at a microscopic level involving macroscopically normal mucosa. The use of aggressive staging evaluation of the GI tract was found to have little impact on patient management decisions in the current study.
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. jromague@mail.mdanderson.org
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Romaguera
authors.forename: L Jeffrey
authors.initials: LJ
authors.lastname: Medeiros
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Hagemeister
authors.forename: Luis E
authors.initials: LE
authors.lastname: Fayad
authors.forename: Maria A
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: Barbara
authors.initials: B
authors.lastname: Pro
authors.forename: Anas
authors.initials: A
authors.lastname: Younes
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Andre
authors.initials: A
authors.lastname: Goy
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Sarris
authors.forename: Nan H
authors.initials: NH
authors.lastname: Dang
authors.forename: Felipe
authors.initials: F
authors.lastname: Samaniego
authors.forename: H M
authors.initials: HM
authors.lastname: Brown
authors.forename: Harish K
authors.initials: HK
authors.lastname: Gagneja
authors.forename: Fernando
authors.initials: F
authors.lastname: Cabanillas
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D016145:Endoscopy, Digestive System; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis*; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies