18F-FDG PET/CT imaging for a gastrointestinal mantle cell lymphoma with multiple lymphomatous polyposis

Figure 1 Images of typical type multiple lymphomatous polyposis. A: Abdominal CT: thickening of the gastric wall (arrow head) was clearly observed; B, C: Gastrointestinal endoscopy: stomach (dye spraying) (B), descending portion of the duodenum (C); D, E: Colonoscopy: transverse colon (D), terminal ileum (E). B-E detected typical multiple lymphomatous polyposis, but none showed uptake on fluorodeoxy-glucose-positron emission tomography/computed tomography.

Figure 2 Images of atypical type multiple lymphomatous polyposis. A, B, D, F, H: [fluorine-18]-fluorodeoxy-glucose -positron emission tomography/computed tomography: (A) Uptake in the gastrointestinal tract was noted at the 4 sites shown in longitudinal images. The SUVmax was 5.1, 6.9, 7.7, and 6.5 in the duodenal bulb (B), rectum (D), ascending colon (F), and cecum (H), respectively; C: Gastrointestinal endoscopy: Three large tumorous lesions circumferentially surrounding the duodenal bulb were observed; E, G: Colonoscopy: Multiple larger nodules than usual type MLP were observed in the rectum (E). The ascending colon was intussuscepted due to a large tumor (G); I: X-ray imaging of the ascending colon and cecum: Large tumorous lesions were observed in the ascending colon and cecum (arrowheads).

Figure 3 Pathological findings. A: Macroscopic specimen showed perforation in the duodenal bulb; B: Histopathologically, lymphoma lesion in the duodenal bulb invaded deep into the muscularis propria (HE stain, x 20); C: Tumor cells varying in size from small to middle-sized densely proliferated (HE stain, x 200); D-F: These tumor cells were positive on immunohistochemical staining for CD20 (D), CD5 (E), and Cyclin D1 (F), findings compatible with mantle cell lymphoma (x 200); G: Ki-67 proliferative (MIB-1) index in the duodenal bulb was 50.2% (1397 cells/2781 cells) (x 200).