Amardeep Singh, MD1, Atul Bali, MD2, Bikram Bal, MD2
1CMG, Powhatan, VA; 2CMG, Farmville, VA
Introduction: Non-Hodgkin Lymphomas (NHL) are a group of malignancies that are derived from immature B cells, T cells and natural killer cells. The incidence of NHL is 19.6 per 100,000 per year in the United States. Mantle cell lymphoma (MCL) is a type of NHL which arises from mature B cells and has a more aggressive clinical course, accounting for 6% of all NHL cases. This amounts to approximately 4200 new cases in the US every year. MCL has a strong predilection for the gut with 92% of patients exhibiting gastrointestinal infiltration.
Case Description/Methods: Our patient is a 68 year old Caucasian male referred for a routine screening colonoscopy. History was notable for MCL involving the hard palate diagnosed in February 2013. This was initially treated with R-CHOP therapy with subsequent Rituximab maintenance. Patient relapsed in February 2015. His relapse was treated with FCR therapy which was completed in June 2015. Follow up bone marrow biopsy was negative. In June 2016 he had recurrence of the malignancy on his hard palate, requiring treatment with local radiation. After completion of radiation, surveillance imaging with integrated whole body PET/CT demonstrated no further activity. He was deemed to be in remission and maintained routine biannual oncologic follow up for three years. Routine screening colonoscopy performed in May 2019, revealed a polyp in the transverse colon, and an additional polypoid lesion in the rectum. Biopsy revealed atypical lymphoid infiltrate consisting of medium sized lymphocytes that were positive for CD5, CD20, CD10, PAX5, Bcl-2, and cyclin D1. Morphology, immunofluorescence, and FISH were positive for t11:14, with pathology being consistent with mantle cell lymphoma. Patient has been referred back to his oncologist to discuss further treatment options.
Discussion: Our case illustrates the importance of endoscopic surveillance in patients with MCL. While PET/CT is invaluable in the surveillance of multiple malignancies, it maybe inadequate in determining remission and recurrence of MCL. The National Comprehensive Cancer Network (NCCN) recommends that both upper endoscopy and colonoscopy be performed to assess treatment response and remission in this population. Given the high incidence of GI involvement in MCL, incorporating routine endoscopic surveillance as part of MCL management may be an important step for early detection of disease recurrence in this high-risk population.
Citation: Amardeep Singh, MD; Atul Bali, MD; Bikram Bal, MD. P0162 - EARLY DETECTION OF MANTLE CELL LYMPHOMA RECURRENCE WITH COLONOSCOPY. Program No. P0162. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.