PMC4188948_01
(A) Colonoscopy revealed a large tumor in the descending colon consistent with mantle cell lymphoma (MCL). (B) Colonoscopy showed partial tumor response of MCL in the descending colon after systemic chemotherapy. (C) Four resolution clips were placed in a "target sign" fashion around MCL tumor tissue to facilitate in radiation therapy planning. (D) Repeat colonoscopy after radiation therapy showed resolution of MCL
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F1
Colonoscopy confirmed a large protruding erythematous hard mass (Fig. 1A) and biopsy was positive for recurrent MCL (Fig. 2A). Colonoscopy revealed a substantial decrease in tumor volume (Fig. 1B) with histology positive for persistent MCL confirming only partial tumor response (Fig. 2B). Four hemostatic resolution clips (Boston Scientific, Massachusetts, USA) were endoscopically placed to mark the superior, inferior, lateral and medial extent of the tumor, in a "shooting target" fashion to facilitate in planned directed external beam RT (Fig. 1C) and to minimize the radius of toxic radiation exposure to the adjacent normal tissue (Fig. 3, arrow). Follow up colonoscopy with biopsy 6 months after RT showed no endoscopic or histologic evidence of residual disease or toxicity (Fig. 1D).