Frequency of gastrointestinal involvement and its clinical significance in mantle cell lymphoma.
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.
Romaguera
Jorge E
JE
Department of Lymphoma/Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. jromague@mail.mdanderson.org
Medeiros
L Jeffrey
LJ
Hagemeister
Frederick B
FB
Fayad
Luis E
LE
Rodriguez
Maria A
MA
Pro
Barbara
B
Younes
Anas
A
McLaughlin
Peter
P
Goy
Andre
A
Sarris
Andreas H
AH
Dang
Nan H
NH
Samaniego
Felipe
F
Brown
H M
HM
Gagneja
Harish K
HK
Cabanillas
Fernando
F
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