Mantle cell lymphoma involving the esophagus evaluated by magnifying endoscopy with narrow-band imaging

A 62-year-old man was referred because of intestinal polyposis. Physical examination revealed diffuse lymphadenopathy and splenomegaly. Laboratory tests showed lactate dehydrogenase of 173 U/L (reference range [RR] 120-250 U/L) and soluble interleukin-2 receptor of 3264 U/mL (RR 220-530 U/mL). Colonoscopy revealed multiple smooth polyps (<10 mm) in the terminal ileum and colon. EGD to determine the extent of the disease revealed multiple whitish flat nodules (<5 mm) in the pharynx and esophagus by white light (A) and narrow-band imaging (B). Magnifying endoscopy with narrow-band imaging showed smooth lesions with treelike abnormal vessels (C). None of the lesions stained with Lugol iodine solution. Histologic examination of biopsy specimens from the pharynx, esophagus, and colon showed nodular aggregates of small lymphocytes in the subepithelium. Immunohistochemical studies revealed expression of CD20, CD5, and cyclin D1 (D, cyclin D1, orig. mag. ×100). The proliferative index assessed by Ki-67 was 40%. 18F-fluorodeoxyglucose positron emission tomography revealed abnormal uptake in the spleen, colon, and lymph nodes on both sides of the diaphragm. The result of pathologic examination of the bone marrow was normal. Thus, the patient received a diagnosis of stage IV mantle cell lymphoma (Lugano classification). The patient underwent chemotherapy, which resulted in obvious shrinking of the lesions in the digestive tract and lymph nodes.