Synchronous collagenous sprue and enteropathy-type T cell lymphoma: variants of the same disease.
A 64-year-old man with treated hypothyroidism had 10 months of diarrhea, abdominal pain, anorexia and recent involuntary 13.6 kg weight loss. He presented to hospital with an acute abdomen that had a radiological correlate of free air under the diaphragm. He was diagnosed with a perforated mid-jejunum due to an ulcerated enteropathy-type T cell lymphoma (ETL), complicating collagenous sprue and cryptic celiac disease. Polymerase chain reaction verified monoclonal gamma- and beta-T cell receptor gene rearrangements in the neoplasm. He had a complete resolution of symptoms when treated with a gluten-free diet in the postoperative period. This is apparently the first report describing collagenous sprue and ETL as synchronous lesions. Because atypical CD8+ lymphocytes are in both the collagenous sprue epithelium and ETL, the implication is that collagenous sprue is a noninvasive component of the ETL.
Medlicott
S A C
SA
Department of Laboratory Medicine and Calgary Laboratory Services, Peter Lougheed and Foothills Medical Centre, 3500-26 Street Northeast, Calgary, Alberta T1Y 6J4, Canada. shaun.medlicott@cls.ab.ca
Beck
P L
PL
Loken
S
S
Crabtree
T
T
D017252:CD3 Complex / Q000032:analysis; D016827:CD8 Antigens / Q000032:analysis; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology; D007580:Jejunal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged
D017252:CD3 Complex; D016827:CD8 Antigens