Monmouth Medical Center, Robert Wood Johnson Medical School of Rutgers University Long Branch, NJ
FNU Payal, MD1, Karan J.. Yagnik, MD1, Ali Wakil, MD2, Sakshi Bai, MD3, Fnu Akash, MD4, Sunny Kumar, MD5, Negar Niknam, MD6, Shazia Shah, MD1 1Monmouth Medical Center, Robert Wood Johnson Medical School of Rutgers University, Long Branch, NJ; 2One Brooklyn Health-Interfaith Medical Center, Brooklyn, NY; 3Henry Ford Jackson Hospital, Jackson, MI; 4Florida State University, Cape Coral, FL; 5Wright Center for Graduate Medical Education, Scranton, PA; 6Icahn school of Medicine at Mount Sinai NYC Health + Hospitals Queens, Gastroenterology Department, Queens, NY Introduction: Mantle cell lymphoma (MCL) is a rare, aggressive subtype of B-cell non-Hodgkin’s lymphoma, comprising approximately 6% of adult lymphomas. It frequently exhibits extranodal involvement, with the gastrointestinal (GI) tract being a common site—described in up to 90% of cases on autopsy studies. Despite this high frequency, GI involvement is often clinically silent and may be missed without targeted evaluation. Endoscopic manifestations are diverse, ranging from lymphomatous polyposis to subtle nodularity, particularly in the duodenum and ileum. Early recognition of such endoscopic findings is essential, as timely histological confirmation can significantly impact therapeutic decision-making and prognosis.
Case Description/
Methods: A 69-year-old male with a known history of mantle cell lymphoma involving the liver, hypertension, pre-diabetes, prostate cancer (status post-radiotherapy), and gastric intestinal metaplasia underwent esophagogastroduodenoscopy (EGD) for surveillance of gastric intestinal metaplasia. The patient was asymptomatic at the time of evaluation. Incidentally, multiple small, well-demarcated white nodules were visualized on the duodenal bulb. Biopsies of these nodules revealed dense infiltration of atypical lymphoid cells, positive for cyclin D1 and CD5, and negative for CD10, consistent with mantle cell lymphoma. Gastric biopsies demonstrated extensive intestinal metaplasia without dysplasia. The patient was referred back to oncology for further systemic staging and continued surveillance. Discussion: This case highlights the importance of maintaining a high index of suspicion for GI involvement in patients with systemic MCL, particularly during surveillance endoscopies. While lymphomatoid polyposis is the classical GI presentation, subtle lesions—such as discrete white nodules or mucosal thickening—can represent early or focal disease. Recent studies emphasize that even asymptomatic GI involvement may carry prognostic relevance, warranting systemic evaluation and, in some cases, therapy adjustment. Endoscopy with targeted biopsy remains the gold standard for detecting occult mucosal disease. This case reinforces the utility of routine surveillance in high-risk individuals and underscores the pivotal role of histopathology, including immunophenotyping, in confirming diagnosis. Early recognition of GI relapse can prevent complications such as obstruction, hemorrhage, or perforation and may improve clinical outcomes.
Disclosures: FNU Payal indicated no relevant financial relationships. Karan Yagnik indicated no relevant financial relationships. Ali Wakil indicated no relevant financial relationships. Sakshi Bai indicated no relevant financial relationships. Fnu Akash indicated no relevant financial relationships. Sunny Kumar indicated no relevant financial relationships. Negar Niknam indicated no relevant financial relationships. Shazia Shah indicated no relevant financial relationships.
FNU Payal, MD1, Karan J.. Yagnik, MD1, Ali Wakil, MD2, Sakshi Bai, MD3, Fnu Akash, MD4, Sunny Kumar, MD5, Negar Niknam, MD6, Shazia Shah, MD1. P1994 - Multiple White Nodules in the Duodenum: An Unusual Endoscopic Finding of Mantle Cell Lymphoma, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
