Multiple lymphomatous polyposis associated with small lymphocytic lymphoma: a unique presentation

Area of Science:

• Hematology
• Gastroenterology
• Oncology

Background:

• Multiple lymphomatous polyposis (MLP) is a rare extranodal lymphoma manifestation, most frequently associated with mantle cell lymphoma (MCL).
• MLP typically presents as multiple polypoid lesions in the gastrointestinal tract.
• Understanding the diverse presentations of MLP is crucial for accurate diagnosis and management.

Observation:

• A 66-year-old male presented with rectal bleeding and was diagnosed with small lymphocytic lymphoma (SLL)/chronic lymphocytic leukemia (CLL).
• Imaging revealed splenomegaly, enlarged lymph nodes, and colonic diverticula.
• Colonoscopy identified multiple polypoid lesions in the colon.

Findings:

• Biopsies of the polypoid lesions showed diffuse lymphoid infiltrate, lacking the characteristic features of MCL.
• Immunohistochemical and FISH studies excluded MCL.
• Bone marrow biopsy confirmed diffuse infiltration by low-grade lymphocytes expressing CD20, CD5, and CD23, consistent with B-cell CLL/SLL phenotype.

Implications:

• This case suggests that MLP may occur in B-cell CLL/SLL, expanding the known clinical spectrum of this condition.
• The findings challenge the established association of MLP primarily with MCL.
• Further research is needed to elucidate the relationship between CLL/SLL and MLP.