Valley Digestive & Liver Care Center Fresno, CA, United States
Min Win, MD1, Thin Myat, MD2 1Valley Digestive & Liver Care Center, Fresno, CA; 2VA Central California Health Care System, Fresno, CA
Introduction: Mantle cell lymphoma is one of the mature B cell, aggressive, non-Hodgkin lymphoma. It is reported an incidence of approximately 4 to 8 cases per million person per year. The number of cases reported of Mantle cell lymphoma of colon is very limited. We report a rare case of polypoid mantle cell lymphoma of the colon presenting with iron deficiency anemia.
Case Description/Methods: 72 year old female with past medical history of gastroesophageal reflux disease, chronic kidney disease presented to outpatient GI clinic for newly diagnosed iron deficiency anemia. Patient has no systemic B symptoms such as a fever, night sweat, and unintentional weight loss. Patient reported RLL quadrant cramps for three months but no bowel habit change or report of sign of GI or GU blood loss. Physical examination showed no lymphadenopathy, splenomegaly or hepatomegaly. Laboratory testing showed unremarkable BMP, LFT, and INR. WBC 7.7, HB 10.3, Platelet 370, iron saturation 7%, Ferritin 5 ng/ml, B12 528 picogram/ml, Folic 24 ng/ml. Fecal occult was positive. Colonoscopy which was done five year ago showed internal hemorrhoids, diverticulosis, sessile serrated adenoma at transverse colon. CT abdomen showed diverticulosis but no enlarged lymph nodes. EGD revealed esophagitis, hiatal hernia, gastritis. colonoscopy revealed several atypical appearing polypoid lesions at cecum, IC valve and ascending colon with normal intervening mucosa. Capsule endoscopy showed unremarkable findings. She received 6 cycles of bendamustine and rituximab and achieved complete clinical remission. She has been on rituximab maintenance. Surveillance colonoscopy 2 year after diagnosis showed complete resolution of polypoid lesions.
Discussion: Mantle cell lymphoma cells are small to medium size B cell lymphocyte with irregular nuclei located in the mantle zone of lymph node. They are typically CD5 + and CD 23 -, 95 % express cyclin D1.
Colorectal lymphoma is accounting for approximately 3% of the GI lymphomas and 0.3% of large intestinal malignancies.
To our knowledge our reported case appear to be the only case found in patient with IDA and nonspecific GI symptoms without lymphadenopathy or systemic B symptoms as most patients have one or both. Through this case report we hope to bring further attention to this distinct clinical entity while adding another case to the current body of literature.
Disclosures: Min Win indicated no relevant financial relationships. Thin Myat indicated no relevant financial relationships.
Min Win, MD1, Thin Myat, MD2. P0220 - Gastrointestinal Mantle Cell Lymphoma Discovered During Iron Deficiency Anemia Work-Up, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.