Enteropathy-type T-cell lymphoma that was pathologically diagnosed as celiac disease.
A 63-year-old woman was referred and admitted to our department for further examination of protein-losing enteropathy (PLE), which was diagnosed by alpha-anti trypsin test. Her symptoms were frequent vomiting, watery diarrhea and hypoproteinemia. Although intensive examination for PLE was performed in her previous hospital, the origin of the disease was not detected. Abdominal computed tomography revealed diffuse enlargement and swelling of the intestine wall and a 5-cm diameter mass with unclear margin, which involved the mesenteric arteries and veins. Total colonoscopy showed a diffuse edematous lesion with hemorrhage at the terminal ileum. Enteropathy-type T-cell lymphoma (ETL) was diagnosed based on a biopsy of the lesion and CD45 gating analysis. Immediate start of chemotherapy (CHOP) led to a transient regression of the tumor even though her symptoms were not improved. During the second cycle of CHOP, the patient died of massive hemorrhage throughout the intestine. The pathological study revealed that intraepithelial CD3-positive clonal T-cells were present in the lesion, indicating that this case could be associated with celiac disease. In light of the histological findings, we concluded that this was a case of ETL associated with celiac disease, which is extremely rare in Japan.
Department of Medicine and Molecular Science, Graduate School of Medicine, Gunma University, Maebashi.
Hidetoshi
H
Yasuoka
Takashige
T
Masuo
Koshi
K
Hashimoto
Koji
K
Sato
Shuichi
S
Okada
Motoyasu
M
Kusano
Takuma
T
Oishi
Hideaki
H
Yokoo
Masaru
M
Kojima
Yoichi
Y
Nakazato
Masatomo
M
Mori
D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D011504:Protein-Losing Enteropathies / Q000209:etiology