Department of Pathology, University of Illinois at Chicago, 840 S. Wood Street, 260 CMET, Chicago, USA.
Department of Internal Medicine, University of Illinois at Chicago, Chicago, USA.
Diagn Pathol. 2022 Jun 25;17(1):53. doi: 10.1186/s13000-022-01237-0.
Primary intestinal T-cell lymphomas are uncommon malignancies that pose a diagnostic dilemma, because the clinical features and imaging findings commonly overlap with those encountered in inflammatory bowel diseases.
The current clinical case report describes the clinical history, laboratory findings and histopathological analysis from a patient with non-specific gastrointestinal symptoms with a presumptive clinical diagnosis of inflammatory bowel disease, and two intestinal biopsy specimens with non-specific findings. Due to the persistent symptoms a third biopsy was consistent with primary intestinal T-cell lymphoma, a diagnosis that was elusive for months after the initial presentation. Clinical correlation with laboratory and histopathological findings is required to establish a definitive diagnosis and to further stratify the patients. In addition, the neoplastic cells featured partial expression of CD30, which had relevant therapeutic implications.
Suspicion for an intestinal T-cell lymphoproliferative disorder should always exist in patients with persistent abdominal symptoms with no clear etiology. The current discussion provides a summary and review of the key diagnostic histological features for the classification of primary intestinal T-cell lymphomas. In addition, the discussion describes how specific the histological findings are relevant for the clinical management decisions.
原发性肠道 T 细胞淋巴瘤是一种罕见的恶性肿瘤,其诊断存在一定的困难,因为其临床表现和影像学表现通常与炎症性肠病相似。
本临床病例报告描述了一位具有非特异性胃肠道症状的患者的临床病史、实验室检查结果和组织病理学分析,该患者最初被临床诊断为炎症性肠病,且两次肠道活检均未见特异性发现。由于症状持续存在,第三次活检提示原发性肠道 T 细胞淋巴瘤,在最初就诊后数月才得到明确诊断。需要结合临床、实验室和组织病理学检查结果来明确诊断,并对患者进行进一步分层。此外,肿瘤细胞部分表达 CD30,这对治疗具有重要意义。
对于持续性腹部症状且病因不明的患者,应始终怀疑存在肠道 T 细胞淋巴增生性疾病。目前的讨论总结并回顾了原发性肠道 T 细胞淋巴瘤分类的关键组织病理学特征。此外,还描述了组织学发现与临床管理决策的相关性。