1. ¹Services d'Anatomie Pathologique, Hôpital Laennec, Paris, France
2. ²Hépatogastro-entérologie, Hôpital Laennec, Paris, France
3. ³Chirurgie Digestive et Générale, Hôpital Laennec, Paris, France
4. ⁴Laboratoire d'Hématologie, Hôpital Necker, Paris, France
5. ⁵Unité INSERM U490, Paris, France

Correspondence: Christophe Rosty, Laboratoire d'Anatomie Pathologique, Hôpital Laennec, 42 rue de Sèvres, 75340 Paris Cedex 07, France; e-mail: christopherosty@hotmail.com; fax: 33 144 39 69 36.

Accepted 22 November 1999.

Abstract

Hereditary nonpolyposis colorectal cancer (HNPCC) is an inherited predisposition to colorectal and endometrial cancers caused by germline mutation of mismatch repair genes, with hMLH1 and hMSH2 underlying the majority of the cases. Although lymphoid tumors are the most common tumors in mouse models for HNPCC, lymphomas are almost never encountered in patients who have HNPCC, except in rare families with germline homozygous deletion of hMLH1. We report the case of a 53-year-old man who had a history of colon cancers related to constitutional hMLH1 mutation and who was diagnosed as having a duodenal follicular lymphoma. This diagnosis was supported by IgH-BCL2 rearrangement and BCL2 immunoreactivity in tumor cells. The association of both of these possibly related rare diseases has never been reported. To clarify this relationship, we searched for hMLH1 expression and mismatch repair deficiency in the duodenal lymphoma. hMLH1 immunostaining was positive in lymphoid tumor cells, and no microsatellite instability was detected. In agreement with mouse models for HNPCC, these results suggest the involvement of alternative mechanisms to complete mismatch repair deficiency for lymphomagenesis in HNPCC syndrome.