An unusual cause of polyposis

Clinical presentation

A 50 year old woman presented with progressive snoring of two months' duration. She denied fever, fatigue, or abdominal pain. On examination, a pharyngeal mass and generalised lymphadenopathy were noted. On palpation, there was no mass or tenderness in the abdomen. Routine blood examination was unremarkable. Colonoscopy for systemic evaluation revealed multiple polypoid lesions in the terminal ileum (fig 1). Most lesions were overlaid with normal mucosa. Numerous small sessile umbilical lesions were identified with indigo carmine dye throughout the colon (fig 2). Stool culture was negative.

Figure 1 Colonoscopy showing multiple polypoid lesions in the terminal ileum.

Figure 2 Colonoscopy with indigo carmine dye demonstrating numerous small sessile umbilical lesions throughout the colon.

Question

What is the diagnosis?

See page 1591 for answer

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