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Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Monday, April 28, 2025
A 67-year-old man presented for a colonoscopy following a positive fecal occult blood test and thrombocytopenia detection. Despite these findings, he remained clinically asymptomatic. His medical history included testicular cancer, for which he was under oncology follow-up.
During colonoscopy, a laterally spreading tumor non-granular lesion measuring 25 × 20 mm was identified in the upper rectum, classified as Paris IIa + IIc. Narrow band imaging and magnifying endoscopy were utilized for evaluation, but due to unclear polyp surface characteristics and pseudo-depression signs, biopsies were taken, noted Lumir Kunovsky, MD, PhD, of the Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic, and colleagues.
Additionally, five smaller lesions (each 4–5 mm) were found in the mid-rectum and removed using cold snare polypectomy. Histopathological analysis confirmed mantle cell lymphoma (MCL) in both the main lesion and smaller polyps.
Following diagnosis, the patient was referred to the Department of Hematology and Oncology, where staging procedures were completed. Imaging revealed generalized lymphadenopathy, and histological and flow cytometric analysis identified minor bone marrow infiltration. The disease was classified as stage IV A according to the Ann Arbor classification.
Treatment with six cycles of rituximab-based chemoimmunotherapy led to complete remission of the lymphoma.
“The gastrointestinal tract is involved in about 4%–9% of all gastrointestinal B-cell non-Hodgkin lymphomas. The most common site of involvement is the terminal ileum in 35%–48% of cases, while rectal involvement is described in approximately 6% of cases…When evaluating rectal masses, even those presenting as solitary lesions that resemble adenocarcinoma, MCL should also be considered in the differential diagnosis,” noted Lumir Kunovsky.
Disclosures: The authors had no conflicts of interest to report.
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