Colon tumor - Mantle cell lymphoma of colon

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Colon tumor

Lymphoma and hematopoietic lesions

Mantle cell lymphoma of colon

Reviewers: Charanjeet Singh, M.D. (see Reviewers page)
Revised: 25 February 2012, last major update February 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Uncommon in colon
● Often presents as multiple lymphomatoid polyposis
● Often present in benign appearing mucosa (Curr Opin Gastroenterol 2005;21:80)
● 88% males, mean age 61 years
● Also involves stomach and small intestine
● Mean survival historically less than 3 years; may be improving with newer treatments
● Rarely co-exists as incidental finding with adenocarcinoma (Arch Pathol Lab Med 2003;127:E64, Mod Pathol 2001;14:811)

Case reports
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● 60 year old man with rectal tumor (Hepatogastroenterology 2001;48:675)
● 61 year old man with diffuse involvement of GI tract without polyposis (J Gastroenterol 2004;39:995)
● 71 year old woman with ulcerative colitis (Am J Surg Pathol 1996;20:1024)
● Woman in 80's (University of Pittsburgh Case #441)

Gross description
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● Nodular, sessile or polypoid lesions, widely spaced and confluent studded or cobblestone appearance
● Each polyp 2 mm to 2 cm
● May be dominant tumor mass in ileocecum
● Endoscopically normal mucosa may have small tumor infiltrates also

Gross images
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Lymphomatoid polyposis

Micro description
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● Mantle cells (small lymphocytes with pale cytoplasm and cleaved nuclei), often invasion of submucosa, proliferation around germinal centers and sparing of mucosa
● Late - epithelial invasion and ulceration
● Note: may also be minute lymphoid infiltrates in known mantle cell patients

Micro images
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Figures 2, 3A-3D

Various images

Incidental tumor

Positive stains
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● CD20, CD5 and cyclin D1 / bcl1
● Immunohistochemistry for cyclin D1 may be more sensitive than FISH for t(11;14) or PCR for IgH (Am J Surg Pathol 2006;30:1274)

Negative stains
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● CD3, CD10 and CD23

Differential diagnosis
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● Nodular lymphoid hyperplasia: benign, associated with common variable immunodeficiency syndrome
● Multiple lymphoid polyps: benign germinal centers in children, patients with Gardner’s syndrome
● MALT lymphoma: may present as multiple lymphomatoid polyposis, but has lymphoepithelial lesions and is negative for CD5 and cyclin D1
● Inflammatory bowel disease: may need immunostains to differentiate (Dig Dis Sci 1992;37:934)

End of Colon tumor > Lymphoma and hematopoietic lesions > Mantle cell lymphoma of colon

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