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ACCEPTED: CLINICAL VIGNETTES/CASE REPORTS—PRACTICE MANAGEMENT

Unusual Recurrence of Mantle Cell Lymphoma to the Colon Without Lymph Node Involvement

2471

Tripathi, Kartikeya MD1; Dunzendorfer, Thomas MD2

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American Journal of Gastroenterology: October 2018 - Volume 113 - Issue - p S1372-S1373
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Mantle cell lymphoma is an aggressive type of B-cell non-Hodgkin lymphoma with common extranodal involvement with a propensity to involve gastrointestinal tract. Virtually all patients with mantle cell lymphoma have refractory disease and the disease recurs with lymph node or bone marrow involvement.

A 79-year-old man presented with progressively worsening constipation for ten days. His past medical history was significant for mantle cell lymphoma diagnosed and treated 5 years before this presentation. At the time of admission, he denied fever or abdominal pain. Physical exam revealed normal vital signs, distended abdomen with normal bowel sounds and a rubbery rectal mass, and no lymphadenopathy. An abdomen and pelvic CT scan showed a sigmoid mass with distension of the proximal colon. A colonoscopy was done which showed diffuse ulceration, erythema, and edema of the rectum and left colon with a fungating mass in the rectum (Figure 1). A 5 cm long stricture at the proximal sigmoid colon causing a partial obstruction was identified and balloon dilation to 2 cm was performed. The patient had a good symptomatic response and was discharged. Pathology of the mass and random biopsies from the left colon showed mantle cell lymphoma. Four days later, the patient returned to the emergency department complaining of intermittent severe crampy abdominal pain. Repeat colonoscopy was performed and a Wilson-Cook metal Z-stent with a diameter of 3.5 cm was placed through the stricture with symptomatic relief. After two hours, the patient developed sudden, severe left lower quadrant abdominal pain with fever, nausea, and vomiting. An abdominal CT showed two small foci of extraluminal air, indicating a sigmoid microperforation with diffuse thickening of the left colon with pericolonic stranding. Consequently, the patient was taken to the operating room where a sigmoid colon perforation and extraluminal liquid stool were identified. A left hemicolectomy and transverse colostomy were performed. The patient recovered well from the procedure and eventually started chemotherapy for recurrent colonic mantle cell lymphoma. This patient was unique as he presented with recurrence of mantle cell lymphoma to the gastrointestinal tract only, without bone marrow or lymph node involvement. Our case highlights laparoscopic-assisted bowel resection as a potential and feasible option in the multidisciplinary treatment of mantle cell lymphoma when recurrence from lymphomatous polyposis occurs.

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2471 Figure 1 No Caption available.
© The American College of Gastroenterology 2018. All Rights Reserved.