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Answer to last weeks image challenge!

Clinical scenario :
      A 77-year-old female presented to our hospital with history of lower GI bleed and colonoscopic examination showed multiple lesions in sigmoid colon and in transverse colon . Fig 1 and Fig 2
Biopsy was taken .


Fig.1 Multiple lesions seen on colonoscopy 

Fig2 Multiple lesions seen 
   
The biopsy revealed features of monotonous sheets of Lymphocytes as shown in figure 3 .The immuno staining was positive for Cyclin D+ and CD 2 positive Fig 4 and 5 below
The overall features were suggestive of MANTLE CELL LYMPHOMA  (MCL)


Fig 4 Immunocytochemistry Cyclin D +

Fig 3 sheets of  lymphocytes seen   
Fig.5 Lymphocytes positive for CD2 
Further reading :
   Extra nodal lymphomas commonly occur in the GI tract. They account for 2% of primary GI tract lymphomas . Non-Hodgkin’s lymphoma of the colon is rare .
MCL is a discrete entity, unrelated to small lymphocytic or small-cleaved-cell lymphomas .
Abdominal pain is the most common symptom and obstruction is unusual;however, reports of intussusception  are known. The majority of patients are elderly as in the index case and have multiple polypoidal lesions ranging from 0.1 to 4 cm with central ulcerations.
Bowel-wall thickening or mass formation developed exclusively in the ascending colon, rectum or
ileum.
Splenomegaly has been frequently observed in these patients.
Our patient had massive splenomegaly reaching up to pelvis with infarcts and underwent elective splenectomy for fear of bleeding and spontaneous rupture.




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