East Carolina University Medical Center Greenville, NC
Jinye Liu, DO1, Abdulazeez Swaiti, MD1, Christin Wilkinson, MD1, Clarimar Diaz-Lopez, MD2, Rami Basmaci, MD1, Parnita Kesar, MD1, Alessandra Martorella, DO3, Aryan Jain, MBA, BS4, M Danial Ali Shah, MD5, Sarah RT. Jahangir, MD6, Deniz Coskuner, MD6, Romina Nomigolzar, MD7, Khaled M.. Elhusseiny, MD1, Taruj , MD1, Christina Santana, MD1, Kena Lemu, MS1, Stephanie Ibarra Lepe, MD1, Saeed S. Graham, MD8, Kara Regan, MD9 1East Carolina University Medical Center, Greenville, NC; 2East Carolina University Medical Center, Greenville, FL; 3MedStar Georgetown University Hospital, Washington, DC; 4Albany Medical Center, Albany, NY; 5Western Michigan University, Kalamazoo, MI; 6ECU Health Medical Center, Greenville, NC; 7ECU Health medical center, Greenville, NC; 8ECU Department of Internal Medicine, Greenville, NC; 9East Carolina Gastroenterology, Greenville, NC Introduction: Mantle cell lymphoma (MCL) is rare and accounts for around 5% of cases of non-Hodgkin’s lymphoma, with an annual incidence of 1 of 200,000 individuals. It typically presents in the 6th and 7th decades of life with a 3:1 ratio of men to women. Systemic symptoms include fever, night sweats, weight loss, and fatigue. Gastrointestinal tract (GIT) involvement can present as diarrhea, abdominal pain, or occult bleeding. We present a patient presenting with unexplained anemia, subsequently found to have disseminated GI mantle cell lymphoma.
Case Description/
Methods: An 81-year-old Caucasian male with GERD, iron deficiency anemia on oral iron, a pancreatic neuroendocrine tumor post pancreatectomy and splenectomy (2017), and prior transduodenal resection of a tubulovillous adenoma presented for ongoing anemia despite supplementation, without evidence of bleeding. EGD revealed mucosal flattening and erosions in the gastric body and antrum, and at the duodenal major papilla. Colonoscopy identified a 3 cm submucosal non-obstructing oozing mass approximately 20 cm from the anal verge. Biopsies from these sites yielded neoplastic lymphoid proliferation involving the lamina propria and submucosa. FISH confirmed a CCND1/IgH t(11;14) translocation consistent with MCL. TP53 was negative. PET scan showed enlarged reactive lymph nodes. The patient was started on acalabrutinib. Despite negative serial imaging, his anemia continued, with a later bone marrow biopsy revealing MCL as well. Discussion: MCL frequently involves extranodal sites, and the GIT is a recognized target. Involvement is often subclinical, emphasizing the importance of biopsies in areas even with mild abnormalities. Frequently involved GIT sites include the small intestine, colon, and stomach, sometimes manifesting as multiple lymphomatous polyposis (MLP). Our patient’s disease reflects proclivity for diffuse mucosal infiltration, with a large polypoid to subtle infiltrative lesions. Diagnosis is confirmed histologically and via immunophenotyping, revealing CD20+, cyclin D1+, and SOX11+ expression with characteristic t(11;14)(q13;q32) translocations. TP53 negativity may predict a favorable response, while positivity implies a disease with conventional chemoimmunotherapy resistance. This case highlights the value of biopsy in areas without overt lesions, considering MCL in older adults with unexplained anemia, and it reinforces the need for comprehensive staging, including PET-CT and bone marrow biopsy, for guiding management.
Figure: Figure 1. Erythematous mucosa noted in the gastric body (A), erosion (yellow arrow) in the gastric antrum (B), major papilla of the duodenum demonstrating erosions (yellow arrows) (C, D).
Figure: Figure 2. 3 cm friable mass located 20 cm from the anal verge (A), with same mass oozing after biopsy with tattooing in the surrounding area (B).
Disclosures: Jinye Liu indicated no relevant financial relationships. Abdulazeez Swaiti indicated no relevant financial relationships. Christin Wilkinson indicated no relevant financial relationships. Clarimar Diaz-Lopez indicated no relevant financial relationships. Rami Basmaci indicated no relevant financial relationships. Parnita Kesar indicated no relevant financial relationships. Alessandra Martorella indicated no relevant financial relationships. Aryan Jain indicated no relevant financial relationships. M Danial Ali Shah indicated no relevant financial relationships. Sarah Jahangir indicated no relevant financial relationships. Deniz Coskuner indicated no relevant financial relationships. Romina Nomigolzar indicated no relevant financial relationships. Khaled Elhusseiny indicated no relevant financial relationships. Taruj indicated no relevant financial relationships. Christina Santana indicated no relevant financial relationships. Kena Lemu indicated no relevant financial relationships. Stephanie Ibarra Lepe indicated no relevant financial relationships. Saeed Graham indicated no relevant financial relationships. Kara Regan indicated no relevant financial relationships.
Jinye Liu, DO1, Abdulazeez Swaiti, MD1, Christin Wilkinson, MD1, Clarimar Diaz-Lopez, MD2, Rami Basmaci, MD1, Parnita Kesar, MD1, Alessandra Martorella, DO3, Aryan Jain, MBA, BS4, M Danial Ali Shah, MD5, Sarah RT. Jahangir, MD6, Deniz Coskuner, MD6, Romina Nomigolzar, MD7, Khaled M.. Elhusseiny, MD1, Taruj , MD1, Christina Santana, MD1, Kena Lemu, MS1, Stephanie Ibarra Lepe, MD1, Saeed S. Graham, MD8, Kara Regan, MD9. P5181 - From the Antrum to the Anus: A Disseminated Case of GI Mantle Cell Lymphoma, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
