Loyola University Medical Center Cleveland, OH, United States
Kent T. Aje, MD, Ayokunle T. Abegunde, MD, MSc, Kamran Mirza, MD, PhD Loyola University Medical Center, Maywood, IL
Introduction: B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is characterized by a progressive accumulation of mature and dysregulated lymphocytes in bone marrow, lymphoid organs, and extra-nodal sites. Extra-nodal involvement has been reported in the lung, pleura, skin, central nervous system, and kidney1. Gastrointestinal involvement is uncommon, and the rare GI complications generally occur only after the transformation of CLL to diffuse large B-cell lymphoma (Richter syndrome)2. In this report, a case of gastrointestinal CLL/SLL involvement was found on routine screening colonoscopy.
Case Description/Methods: A 71-year-old female with a past medical history of asthma, anxiety, and depression was referred for a screening colonoscopy. Family history is significant for colorectal cancer in her father at age 52 and a sibling with CLL/SLL. Routine colonoscopy 5 years prior was reportedly normal. Colonoscopy revealed a 6 mm sessile polyp in the ascending colon. Microscopic examination of the polyp revealed dense lymphoid infiltrate comprised of small, monotonous appearing lymphoma cells that were CLL/SLL phenotype with immunohistochemistry positivity for CD20, co-expression of dim CD5, and absence of cyclin-D1 expression
Discussion: CLL/SLL accounts for approximately 25 to 30% of all leukemia in the U.S. Median age at diagnosis is approximately 70 years. Patients with GI infiltration of CLL/SLL may be asymptomatic like the patient described in this report, or present with persistent diarrhea, abdominal pain, and GI bleeding, mimicking inflammatory bowel disease, microscopic colitis, ischemic colitis, or colon cancer1,2,4. Endoscopy may reveal normal mucosa, single polyps, multiple polypoid lesions, and focal ulceration 1,2, 4. The patient requires a screening colonoscopy in 5 years because of her family history of CRC in a first-degree relative but she does not require specific endoscopic surveillance for CLL/SLL. However, endoscopy should be considered in patients with CLL/SLL that develop new GI symptoms.
Figure: Legend A. 6 mm ascending colon polyp B. H&E stain a dense lymphoid infiltrate comprised of small-sized monotonous lymphocytes C. Positive CD 5 stain D. Reactive T-cells highlighted by positive CD3 stain E. Positive CD 20 stain F. Negative Cyclin D stain
Kent Aje indicated no relevant financial relationships.
Ayokunle Abegunde indicated no relevant financial relationships.
Kamran Mirza indicated no relevant financial relationships.
Kent T. Aje, MD, Ayokunle T. Abegunde, MD, MSc, Kamran Mirza, MD, PhD. P1334 - Intestinal Infiltration of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Found on Screening Colonoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.