Adult T-cell leukemia/lymphoma presenting multiple lymphomatous polyposis

Abstract

Multiple lymphomatous polyposis (MLP) is an unusual form of non-Hodgkin's lymphoma characterized by polyps throughout the gastrointestinal tract. It has been reported that most MLP are observed in cases with mantle cell lymphoma of B-cell type. We herein present a case of a 66-year-old man with adult T-cell leukemia/lymphoma (ATLL). Colonoscopy revealed MLP throughout the colon and histopathological findings of ATLL cell infiltration. The patient died despite combination of chemotherapy. The literature of manifestations of colonic involvement of ATLL is reviewed and the importance of endoscopic evaluation to differentiate ATLL intestinal lesions from opportunistic infectious enterocolitis is discussed.

Figure 1

Colonoscopic images of the transverse colon. A: Multiple small polypoid lesions were presented; B: Closer observation revealed tiny submucosal tumors as well as whitish polypoid lesions.

Figure 2

Colonoscopic images with indigo carmine dye. A: Multiple lymphomatous polyposis was clearly depicted; B: Closer observation revealed polypoid and aphthoid lesions had tiny central depression.

Figure 3

Pedunculated colonic mucosal tissue. Biopsy specimens of the polypoid lesion showing diffuse proliferation of atypical lymphoid cells in the mucosal layer (A, HE, × 100). The lymphoma cells display pleomorphic nuclei and pale cytoplasm. (B, HE, × 400).

Figure 4

Immunohistochemical studies. The lymphoma cells were positive for CD3 (A, × 400), CD25 (B, × 400) and CD30 (C, × 400), consistent with ATLL, anaplastic large cell variant.