Kitano Yurie, Oura Shoji, Mushiake Yutaka, Makimoto Shinichiro
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Case Rep Oncol. 2021 Sep 9;14(3):1283-1288. doi: 10.1159/000518080. eCollection 2021 Sep-Dec.
A 80-year-old man with the history of operations for gastric cancer and adhesive ileus developed abdominal pain. Positron emission computed tomography (CT) showed prominent wall thickening in the ileum with a maximal standardized uptake value of 12.1. Prior CT to diagnose adhesive ileus just taken only 4 months before did not show any masses in the abdomen. Single-balloon enteroscopy via colon showed a protruding mass at approximately 40-50 cm proximal point from the ileum end. Pathological examination of the biopsied specimen showed diffuse infiltration of medium- to large-sized atypical lymphocytes. Immunohistochemistry analysis showed that the atypical cells were positive for CD3 and CD56 and negative for CD8 and CD20. MIB-1 labeling index was extremely high as 80%. Under the diagnosis of intestinal T-cell lymphoma, the patient underwent tumorectomy, leading to the diagnosis of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) after the negativity confirmation of Epstein-Barr virus-encoded mRNAs. The patient recovered with manageable complication and is going to receive chemotherapy. This is the first case of MEITL with extremely rapid progression in the distal ileum to be observed and diagnosed with single-balloon enteroscopy.
一名有胃癌手术和粘连性肠梗阻病史的80岁男性出现腹痛。正电子发射计算机断层扫描（CT）显示回肠壁显著增厚，最大标准化摄取值为12.1。仅在4个月前用于诊断粘连性肠梗阻的前次CT检查未显示腹部有任何肿块。经结肠单气囊小肠镜检查显示，在距回肠末端约40 - 50 cm处有一突出肿块。活检标本的病理检查显示中到大的非典型淋巴细胞弥漫浸润。免疫组织化学分析显示非典型细胞CD3和CD56呈阳性，CD8和CD20呈阴性。MIB - 1标记指数极高，达80%。在诊断为肠道T细胞淋巴瘤后，患者接受了肿瘤切除术，在确认爱泼斯坦 - 巴尔病毒编码的mRNA为阴性后，确诊为单形性亲上皮性肠道T细胞淋巴瘤（MEITL）。患者康复，并发症可控，即将接受化疗。这是首例通过单气囊小肠镜观察和诊断的远端回肠进展极快的MEITL病例。
