title: Multiple lymphomatous polyposis associated with small lymphocytic lymphoma: a unique presentation.
abstract: Multiple lymphomatous polyposis (MLP) is a rare extra-nodal manifestation of lymphoma. In most cases, MLP is associated with mantle cell lymphoma (MCL). We report a 66-year-old male diagnosed with small lymphocytic lymphoma (SLL)/chronic lymphocytic lymphoma (CLL), who showed evidence of rectal bleeding. A CT-scan of the abdomen and pelvis showed an enlarged spleen, multiple paraaortic and mesenteric lymph nodes, and some diverticular pouching along the antimesenteric border of the pelvic colon. A colonoscopy revealed the presence of multiple polypoid lesions, biopsies of which showed diffuse lymphoid infiltrate without any identifiable follicles. Immunohistochemical analysis combined with a Fluorescence In-Situ Hybridization (FISH) study excluded the diagnosis of MCL. A bone marrow aspiration biopsy demonstrated diffuse infiltration of the bone marrow with low grade lymphocytes that expressed CD 20, CD5 and CD23, with negative BCL-1, t (11; 14) and cyclin D1. A diagnosis of B-cell CLL with kappa light chain restriction was made. Multiple lymphomatous polyposis is considered to be a digestive counterpart to MCL and can therefore be considered as a presentation of MCL. In our case, the polypoid lesions failed to show the characteristic features of MCL. The patient's bone marrow revealed a B-cell lymphoma of CLL/SLL phenotype, which to our knowledge has not been linked to MLP in previously reported cases.
authors.affiliation: The Brooklyn Hospital Center of Cornell Medical College, Brooklyn, NY; Section of Medical Oncology Yale University School of Medicine 333 Cedar str, FMP, 116, New Haven, CT 06520, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Khaled
authors.forename: Vladimir
authors.initials: V
authors.lastname: Gotlieb
authors.forename: Isaiah P
authors.initials: IP
authors.lastname: Schuster
authors.forename: M Wasif
authors.initials: MW
authors.lastname: Saif
mesh_terms: D000368:Aged; D001402:B-Lymphocytes / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism; D001853:Bone Marrow / Q000473:pathology; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D020522:Lymphoma, Mantle-Cell / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D008297:Male
chemical_list: D014408:Biomarkers, Tumor