A 74-year-old man with a history of ischaemic heart disease treated with beta-blockers, isosorbide mononitrate, antiplatelet agents and proton pump inhibitors. He was referred to the Digestive System for a 9-month history of intense asthenia, anorexia and progressive increase in sweating, with a weight loss of 15 kg, associated with diffuse abdominal pain and abdominal distension. Laboratory tests revealed iron deficiency anaemia. Among other diagnostic tests, a colonoscopy under sedation was requested.
An initial colonoscopy was performed, revealing from the rectum to the cecum an infinity of sessile lesions with a polypoid appearance of between 3-6 mm, more frequent in number in the right colon and forming conglomerates at the level of the ileocaecal valve, also affecting the terminal ileum. The pathological anatomy of biopsies at different levels showed non-specific colitis with lymphoid follicular hyperplasia and an eosinophilic infiltrate of up to 60% of inflammatory cells.
After the results obtained and in view of the patient's progressive clinical worsening, it was decided to perform a gastroscopy and repeat the colonoscopy to take new biopsies. Multiple sessile polypoid lesions of different sizes (larger than 8-9 mm) were observed in the gastric and duodenal mucosa. They were irregular and bulging with marked vascularisation, some eroded at the apex, decreasing in number as the patient progressed towards the distal duodenum, and the lesions described in the previous colonoscopy were also confirmed. The histopathological result of the gastric, duodenal and colon biopsies was a dense diffuse lymphoid infiltrate in the mucosa and submucosa with glandular destruction and lymphoepithelial lesion, with small-sized lymphocytes and centrocytoid habitus with positivity for CD 20, cyclin D1, and bcl-2 with a Ki-67 of 30%, all compatible with gastric, small intestine and colon infiltration by mantle lymphoma.
After the endoscopic findings, the patient was referred to the haematology department where studies were completed, confirming the definitive diagnosis of stage IVB non-Hodgkin's lymphoma of the mantle with gastric, small and large intestine involvement.