Zhang Meng-Yuan, Min Cong-Cong, Fu Wei-Wei, Liu Hua, Yin Xiao-Yan, Zhang Cui-Ping, Tian Zi-Bin, Li Xiao-Yu
Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
World J Clin Cases. 2020 Nov 26;8(22):5781-5789. doi: 10.12998/wjcc.v8.i22.5781.
Enteropathy-associated T-cell lymphoma (EATL) is a rare invasive lymphoma derived from gastrointestinal epithelial T lymphocytes. EATL involving the whole gastrointestinal tract accompanied with early colon cancer is extremely rare.
We present the case of a 67-year-old man with diarrhea for more than 5 mo whose colonoscopy in another hospital showed multiple colonic polyps, which indicated moderate to severe dysplasia and focal early cancer. Therefore, he was referred to our hospital for further endoscopic treatment. Colonoscopy after admission showed that the mucosa of the terminal ileum and the entire colon were slightly swollen and finely granular. Endoscopic mucosal resection was performed for colonic polyps located in the liver flexure of the colon and descending colon, respectively. Histopathological findings revealed diffuse infiltration of medium-sized lymphoid cells in the colonic mucosa and visible lymphoepithelial lesions. The histopathology of the polyp in the descending colon indicated moderately differentiated adenocarcinoma limited to the mucosa with negative resection margins. Additionally, immunohistochemical analysis showed positive staining for CD7 and CD8. Therefore, we arrived at a diagnosis of EATL with early colon cancer. Subsequently, the patient was transferred to the hematology department for chemotherapy. The patient's diarrhea was not significantly relieved after receiving chemotherapy, and he ultimately died of severe myelosuppression.
EATL should be considered in unexplained chronic diarrhea. EATL progresses rapidly with a poor prognosis, especially when accompanied with early colon cancer.
肠病相关T细胞淋巴瘤（EATL）是一种罕见的起源于胃肠道上皮T淋巴细胞的侵袭性淋巴瘤。累及全胃肠道并伴有早期结肠癌的EATL极为罕见。
我们报告一例67岁男性，腹泻5个多月，外院结肠镜检查显示多发结肠息肉，提示中度至重度发育异常及局灶性早期癌。因此，他被转诊至我院接受进一步内镜治疗。入院后结肠镜检查显示回肠末端及整个结肠黏膜轻度肿胀，呈细颗粒状。分别对位于结肠肝曲和降结肠的结肠息肉进行了内镜黏膜切除术。组织病理学检查发现结肠黏膜有中等大小淋巴细胞弥漫浸润，并可见淋巴上皮病变。降结肠息肉的组织病理学检查显示为中分化腺癌，局限于黏膜层，切缘阴性。此外，免疫组化分析显示CD7和CD8染色阳性。因此，我们诊断为EATL合并早期结肠癌。随后，患者转至血液科进行化疗。患者化疗后腹泻未明显缓解，最终死于严重骨髓抑制。
对于不明原因的慢性腹泻应考虑EATL。EATL进展迅速，预后较差，尤其是合并早期结肠癌时。
