title: Gastrointestinal Mantle Cell Lymphoma-A Tale of Two Endoscopies.
abstract: BACKGROUND
  A 52-year-old male with a 2-year history of typical gastroesophageal reflux symptoms and concomitant weight loss despite good appetite is presented in this paper. Endoscopy showed hypertrophic gastric folds and multiple antral ulcers which were considered benign both histologically and macroscopically. The diagnosis at the time of presentation was moderate chronic gastritis. Eighteen months later, the patient presents with overt adenopathy in all peripheral lymph nodes and was subsequently diagnosed with mantle cell lymphoma (MCL).
  
  
  CONCLUSIONS
  On second presentation, the patient underwent a repeat endoscopy with biopsy and immunohistochemical (IHC) testing of gastrointestinal and lymph node tissue. The gastrointestinal endoscopy showed multiple polypoid nodules in the first and second parts of the duodenum and multiple sessile polypoid masses carpeting the colon. Gastric and lymph node biopsies were consistent with a diagnosis of MCL and MLP showing immunoperoxidase staining positive for cyclin D1, CD20 and bcl-2. A repeat IHC testing of the gastrointestinal tissue collected on initial endoscopy also showed a positive expression of the IHC markers consistent with MCL. In retrospect, an earlier detection of MCL was possible when the patient had first presented.
authors.affiliation: Discipline of Surgery, The University of Sydney, Sydney Medical School Nepean, Level 5, South Block, P.O. Box 63, Penrith, NSW 2751, Australia.|The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
authors.forename: Marc M
authors.initials: MM
authors.lastname: Dantoc
authors.affiliation: Discipline of Surgery, The University of Sydney, Sydney Medical School Nepean, Level 5, South Block, P.O. Box 63, Penrith, NSW 2751, Australia. eslickg@med.usyd.edu.au.|The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia. eslickg@med.usyd.edu.au.
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.affiliation: Department of Anatomical Pathology, Nepean Hospital, Penrith, NSW, Australia.
authors.forename: Stuart S
authors.initials: SS
authors.lastname: Adams
authors.affiliation: Department of Gastroenterology, Nepean Hospital, Penrith, NSW, Australia.
authors.forename: Jamshid S
authors.initials: JS
authors.lastname: Kalantar
mesh_terms: D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis