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I read with interest the letter by Watanabe et al on a case of mantle cell lymphoma (MCL), which showed a complete response to combination chemotherapy (Gut 2007;56:449–50). Their patient had multiple lymphomatous polyposis and subsequent biopsy confirmed the diagnosis of colonic MCL. In the Europe and North America it has been known that multiple lymphomatous polyposis is commonly considered to be a representation of MCL. The authors have rightly observed that in Japan cases of MCL with multiple lymphomatous polyposis are rare. Several theories have been put forward regarding this difference, including the differences in physiology, between patients in Japan and Western countries. One observation is that MCL is characterised by positive immunoreactivity for cyclin D1 in the biopsied samples reported from Western centres. The authors refer to a study published from Japan which showed that about 10% cases with a confirmed diagnosis of MCL showed no cyclin D1 overexpression. It has been argued that true MCL should show positive immunoreactivity for cyclin D1, and that MCL with no immunoreactivity to cyclin D1 should be considered to be a low grade MCL-like B cell lymphoma. Cyclin D1 negative MCLs, however, can be positive for cyclin D2, as shown in a recent Chinese series.1
A male patient of ours presented with a history of frequent bowel motions with rectal bleeding and weight loss. The patient told us that he had been diagnosed with ulcerative …
Conflict of interest: None declared.
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