Endoscopic diagnosis of primary and recurrent mantle cell lymphomas.

A 64-year-old male presented to our center with epigastric pain, anorexia, fatigue, weight loss, and anemia on laboratory study. An abdominal ultrasound revealed thickening of gastric walls. Upper endoscopy demonstrated a 40 mm ulcerated lesion at the incisura angularis. Biopsy of the lesion revealed a lymphocytic infiltrate expressing CD5, CD20 and Cyclin D1, typical of Mantle-Cell Lymphoma (MCL). Stage IV MCL was diagnosed after description of generalized lymph node enlargement and extensive bone marrow invasion on cross-sectional imaging and bone biopsy, respectively. The patient underwent systemic chemotherapy and autologous hematopoietic stem cell transplant (HSCT). An upper endoscopy performed 100 days after HSCT for evaluation of postprandial epigastric discomfort exhibited multiple ulcerated polypoid at the fundus and a 40 mm polyp with central ulceration. Histopathologic characterization confirmed MCL relapse with microscopic features of aggressiveness (blastoid variant and increased proliferative index). Subsequent rapid progression of the hematologic disease led to patient's death, approximately two months after the diagnosis of recurrence.