Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.2049
Peer-review started: February 20, 2019
First decision: May 31, 2019
Revised: June 11, 2019
Accepted: June 20, 2019
Article in press: June 21, 2019
Published online: August 6, 2019
Anaplastic large cell lymphoma (ALCL) is a type of T-cell lymphoma that can be divided into two categories: anaplastic lymphoma kinase-positive (ALK+) and ALK-negative. Gastrointestinal ALK+ ALCL is rare. Multiple lymphomatous polyposis (MLP) is thought to be a representative form of gastrointestinal lesion in mantle cell lymphoma, and T-cell lymphomas seldom show this feature. Here, we report the first known case of ALK+ ALCL with gastroduodenal involvement to present with MLP.
The patient was a 43-year-old man who was complained of a mass in the left inguinal area and was performed open biopsy. ALK+ ALCL was diagnosed pathologically. Computed tomography scan demonstrated multiple lymph node lesions in the abdomen - pelvis/inguinal region, and scattered nodular lesions in both lung fields. He did not complain of gastrointestinal symptoms. While, esophagogastroduodenoscopy identified MLP lesions from the antrum of the stomach to the descending portion of the duodenum and mild thickened folds on the corpus of the stomach, and biopsy showed invasion of ALK+ ALCL. We treated this patient with six cycles of CHOEP (Cyclophosphamide, Doxorubicin, Vincristine, Etoposide, and Prednisone) chemotherapy. At the conclusion of treatment, there was complete remission. Numerous white scars were found on the stomach, endoscopically consistent with a remission image of lymphoma. The endoscopic features of this case were thought to be similar to those of MCL.
The macroscopic/endoscopic features of gastrointestinal ALK+ ALCL may be more similar to those of B-cell lymphomas rather than T-cell lymphomas.
Core tip: Anaplastic large cell lymphoma (ALCL) encompasses two distinct categories: anaplastic lymphoma kinase-positive (ALK+) and ALK-negative. ALK+ ALCL cases rarely involve the gut. However, in a very small number of case reports, gastrointestinal ALK+ ALCL exhibits a fungating growth pattern, similar to that of B-cell lymphomas rather than T-cell lymphomas. Multiple lymphomatous polyposis (MLP) is thought to be a typical form of gastrointestinal lesion in mantle cell lymphoma, but it develops in other B-cell lymphomas. T-cell lymphomas seldom present with MLP. Here, we report the first known case in the world of ALK+ ALCL with gastroduodenal involvement presenting with MLP.