Colonic polyposis in 15,5- year- old boy with a history of large cell anaplastic lymphoma (LCAL)

Brodkiewicz A, Peregud-Pogorzelski J, ¹Kurzawski G, ²Długosz A, Czaja-Bulsa G, Fydryk J

I^st Department of Paediatrics, Genetics and Pathology Department¹ and Department of Gastroenterology², Pomeranian Medical University, Poland

We describe a case of 15,5-year-old boy born full-term of the second pregnancy and the second delivery. Previous family history was unknown (adopted child). In January 1997 the boy presented subcutaneous tumors and was admitted to the Ist Department of Paediatrics. The changes were removed surgically. Histopathological studies of the excised material revealed LCAL derived from the T cell lineage. Patient was scheduled as IV clinical stage for the LCAL 93 protocol. Complete clinical remission was achieved. Patient was re-admitted in August 1999 due to the rectal bleeding, requireing blood transfusion. Colonoscopy revealed 24 sigmoid and descending colon polyps. Results of other examinations revealed no further abnormalities. Three colonoscopies accompanied by polypectomy were scheduled for the 3 consecutive weeks. Due to the size of the lesions and technical problems only 9 polyps were eventually removed. Histopathological investigation revealed tubular adenoma with hyperplastic polyp pattern, tubular adenoma with focal dysplasia. DHPLC, ASO and PCR-RFLP tests excluded the presence of 12 most important mutations of hMSH2, hMLH1 and hAPC genes (no possibilities to check biological parents). Because of the imminent rectal bleeding the patient was scheduled for partial colectomy.

The authors would like to underline the rare incidence (and coexistence) of LCAL and colonic polyposis in children, severity and size of the polyps, problems in diagnosing AFP and difficulties in qualification for the partial colectomy in the described case.

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