Kawakita Hideaki, Aota Yasuo, Osaka Yoshiaki, Sutoh Arisa, Watanabe Takafumi, Sugiyama Yuji, Kato Fumiaki, Enomoto Masanobu, Ishizaki Tetsuo, Katsumata Kenji, Nagakawa Yuichi
Dept. of Gastrointestinal and General Surgery, Kohsei Chuo General Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1473-1475.
Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is classified under type Ⅱ enteropathy-associated T-cell lymphoma(EATL). It is a rare disease with a low incidence rate. This study reports a case of a patient with MEITL who developed small intestinal perforation during chemotherapy. The patient was a 55-year-old woman who presented to a previous clinic with epigastric pain. Enteroscopy results showed a map-like ulcer in the jejunum. Examination of the tissue specimen collected from this site suggested T-cell lymphoma. The patient was referred to our hospital for chemotherapy. Seven days following the initiation of chemotherapy, an abdominal computed tomography(CT)revealed free air, leading to a diagnosis of gastrointestinal perforation. Emergency surgery was performed. Intraoperatively, bowel perforation and a degenerative ulcer were observed at 95 cm and 80 to 115 cm from the Treitz' ligament, respectively. In addition, all-layer intestinal necrosis was noted 150 and 90 cm from the terminal ileum. Total resection and anastomosis were performed. Postoperatively, the patient developed sepsis due to chemotherapy-related pancytopenia but recovered. She was discharged on postoperative day 24. Subsequently, positron emission tomography(PET)-CT revealed residual intestinal tumor cells and peritoneal dissemination. Chemotherapy was initiated, but there was no response. The patient died after 6.5 months. A radical treatment for MEITL has not yet been established. More case reports are needed to improve the prognosis of this disease.
单形性上皮趋化性肠道T细胞淋巴瘤（MEITL）归类于Ⅱ型肠病相关T细胞淋巴瘤（EATL）。它是一种罕见疾病，发病率较低。本研究报告了1例MEITL患者在化疗期间发生小肠穿孔的病例。该患者为一名55岁女性，因上腹部疼痛就诊于之前的诊所。肠镜检查结果显示空肠有地图样溃疡。对该部位采集的组织标本进行检查提示为T细胞淋巴瘤。患者被转诊至我院进行化疗。化疗开始7天后，腹部计算机断层扫描（CT）显示有游离气体，诊断为胃肠道穿孔。遂进行急诊手术。术中，分别在距屈氏韧带95 cm处观察到肠穿孔，在距屈氏韧带80至115 cm处观察到退行性溃疡。此外，在距回肠末端150 cm和90 cm处可见全层肠坏死。进行了肠段全切除及吻合术。术后，患者因化疗相关的全血细胞减少而发生败血症，但最终康复。患者于术后第24天出院。随后，正电子发射断层扫描（PET）-CT显示肠道仍有残留肿瘤细胞及腹膜播散。开始化疗，但无反应。患者在6.5个月后死亡。目前尚未确立MEITL的根治性治疗方法。需要更多的病例报告来改善这种疾病的预后。
