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spread of mantle cell lymphoma (MCL) frequently involves the colorectum and the stomach [1]. However, involvement of the small intestine has not yet been sufficiently studied. This is a first report of MCL in which involvement of the entire small intestine was studied by double− balloon endoscopy (DBE). A 62−year−old man with a positive fecal occult blood test underwent total colo− noscopy. Colonoscopic pictures showed numerous small polypoid lesions throughout the colorectum. Polypoid le− sions were conspicuous in the cecum, ileocecal valve (l" Fig. 1 a), and rectum (l" Fig. 1 b). Biopsy specimens taken from polypoid lesions revealed diffuse proliferation of small to medium−sized cleaved lymphocytes which were positive for CD5, CD20, and cyclin−D1. We made a diagnosis of MCL presenting as multiple lymphomatous polyposis (MLP). Esopha− gogastroduodenoscopy showed antral gastritis and duodenitis, and biopsy spe− cimens taken from the affected sites re− vealed MCL. DBE was undertaken in order to investigate the extent of the MCL. DBE from the anal approach showed flat, dish− like lesions (l" Fig. 2 a), multiple small polypoid lesions (l" Fig. 2 b), and giant folds (l" Fig. 2 c) in the ileum. Biopsy spe− cimens taken from the ileal lesions also revealed MCL (l" Fig. 2 d). There were no remarkable lesions in the jejunum when examined using the oral approach. Ab− dominal CT study showed multiple lymph node swellings and hepatosplenomegaly. Biopsy specimens taken from bone mar− row revealed MCL. Systemic chemother− apy with cyclophosphamide, doxorubi− cin, vincristine, prednisone (CHOP), and rituximab was started and partial re− sponse was demonstrated after eight cy− cles. The patient was alive without dis− ease progression 20 months later. The endoscopic characteristics of gastro− intestinal tract involvement in MLP have been described in the colorectum and gastritis in the stomach [1]. In the present case we demonstrate various endoscopic features of small−intestinal involvement in MCL, such as flat, dish−like lesions, multiple small polypoid lesions, and giant folds. DBE was useful for diagnosing the extent of MCL involvement of the small intestine.

Mantle cell lymphoma presenting as multiple lymphomatous polyposis spreading widely to the small intestine and diagnosed by double-balloon endoscopy