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Endoscopic features of enteropathy-associated T-cell lymphoma. (a) Ulcerative type in the ileum. (b) Epithelial mass type in the duodenum. (c) Diffuse infiltration type in the gastric body. (d) Nodular type in the descending colon d c
Source publication
Methods:
In this retrospective study, we investigated the endoscopic and clinical features of patients with EATLs at a tertiary center, from January 2008 to October 2020.
Results:
From a total of 248 patients with primary intestinal lymphoma, only 11 patients were finally diagnosed with EATLs, all of which were EATL type II. Men were affected tw...
Contexts in source publication
Context 1
... and Z. Y.) retrospectively reviewed the endoscopic images of all the patients. Based on the endoscopic features, EATLs were classified into four endoscopic types: ulcerative type, epithelial mass type, diffuse infiltration type, and nodular type [ Figure 1]. Ulcerative type was defined as multiple, large, and deep ulcers in the gastrointestinal tract with/without bleeding or perforation. ...
Citations
... Biopsy can be obtained endoscopically; however, initial histological confirmation of EATL from endoscopic biopsy specimens is as low as 36.4%, 10 and therefore, laparotomy may be required for fullthickness biopsy specimens in cases of diagnostic uncertainty. 3 However, approximately 50% of patients present acutely with obstruction, perforation, or gastrointestinal hemorrhage 11 and at a late stage with advanced disease. 3 Diagnosis is then made at emergency laparotomy, which demonstrates ulcerating intestinal mucosal masses. ...
Enteropathy-associated T-cell lymphoma (EATL) is a rare but serious complication of celiac disease. Diagnosis is challenging. Patients can present with weight loss, abdominal pain, and diarrhea or acutely with bowel perforation or obstruction. Patients often present with advanced disease. Malnutrition further limits treatment options. Early diagnosis is important to start aggressive treatment strategies. However, even with prompt diagnosis, prognosis remains poor with a high mortality rate. We report the first documented case of sole tonsillar involvement, a rare extraintestinal and extranodal site of disease, leading to EATL diagnosis. We also highlight some of the challenges in diagnosing EATL.
Rationale
Intestinal T-cell lymphomas are exceedingly rare diseases. Intestinal T-cell lymphoma NOS, as a “wastebasket” category, is difficult to diagnosis. Endoscopy can identify abnormal mucosa in most patients at a reasonably early stage. Therefore, it is crucial to increase the understanding of endoscopists in terms of the endoscopic characteristics of ITCL.
Patient concerns
A 74‐year‐old male alone with wasting as the major complaint, had multiple polypoid lesions in the large intestine. The patient then had endoscopic care.
Diagnoses
Only 1 polypoid lesion on white-light endoscopy in the sigmoid colon was pathologically diagnosed as intestinal T-cell lymphomas, not otherwise specified (ITCL-NOS).
Interventions
The patient underwent intensity-reduced CHOP therapy.
Outcomes
The patient is still with controlled disease but developed chemotherapy-related side effects.
Lessons
In the individual with unexplained anemia and waste, endoscopy should not be delayed. For each of polypoid lesion on white-light endoscopy, the endoscopist need to remain cautious, because every lesion in the same patient can exhibit the independence of histopathological features. Meanwhile, we suggest that endoscopists should routinely observe the terminal ileum, even take biopsy samples if necessary.
