Endoscopic Findings of Enteropathy-Associated T-Cell Lymphoma Type II: A Case Series

Abstract

Enteropathy-associated T-cell lymphoma (EATL) is a rare extranodal T-cell lymphoma arising from the intestine. Two types of EATL have been reported. In contrast to the classic EATL type I, EATL type II occurs sporadically, is unrelated to celiac disease, and comprises 10% to 20 % of all EATL cases. A total of five cases of EATL type II were diagnosed at our clinic from January 2009 to September 2012. Four of the five patients were diagnosed with the help of endoscopy. Among the four patients, two of the cases involved both the small and large intestines, whereas in the other two patients, EATL was limited to the small intestine. Common endoscopic findings included innumerable fine granularities (also called mosaic mucosal patterns) and diffuse thickening of the mucosa with a semicircular shallow ulceration in the lesions of the small bowel. In contrast, the endoscopic findings of the colon were nonspecific and could not distinguish EATL type II from other diseases. There are only few published reports regarding the representative endoscopic findings of EATL. Here, we present the clinical and endoscopic findings of four cases of EATL type II diagnosed by endoscopy.

Multiple lesions of gastrointestinal tract invasion by monomorphic epitheliotropic intestinal T-cell lymphoma, accompanied by duodenal and intestinal enteropathy-like lesions and microscopic lymphocytic proctocolitis: a case series

“…The endoscopic findings in 12 of the 15 reported cases of MEITL included circumferential ulcerated tumors and an edematous and granular mucosa, with a nodular or mosaic pattern, in the duodenum, jejunum, and ileum (Table 3 ) [ 15 – 24 ]. In addition, in all four patients, the non-neoplastic lesions consisted of an edematous or granular mucosa, with or without villous atrophy, in the duodenum and intestine.…”

“…While of uncertain etiology, both lymphocytic and collagenous microscopic colitis are occasionally seen in patients with coeliac disease, hypothyroidism, diabetes mellitus, and rheumatoid arthritis [ 26 ]. In three reported cases of colonic MEITL, ulcerated tumors and hyperemic as well as normal-looking mucosa outside the tumors were detected (cases 2, 11, and 12 in Table 3 ) [ 15 , 23 , 24 ]. However, only the patient described by Kim et al had colonic MEITL characterized by presumably normal mucosa with tumor cell invasion [ 23 ].…”

Monomorphic epitheliotropic intestinal T-cell lymphoma may mimic intestinal inflammatory disorders

“…In a report of four cases, innumerable fine mucosal granules and diffuse thickening of the mucosa with semicircular shallow ulcerations were described in the small bowel and nonspecific changes in colon. 6 The endoscopic appearance in our first case differed from the above, with scattered shallow ulcerations with superficial exudates throughout the colon, within a background of rough mucosa with loss of vascular pattern. This pattern likely caused the initial consideration of UC.…”

Endoscopic and clinicopathological characteristics of colorectal T/NK cell lymphoma

“…It was reported that lymphoma cells in 21 of 31MEITL (68%) as well as 31 of 56 GI ATLL patients (55%) showed expression of CD103 homing receptor of T-IELs, and ATLL had similar histopathological characteristics to MEITL with respect to increased atypical and reactive T-IELs [18]. The endoscopic ndings of MEITL have been reported as edematous mucosa with mosaic and diffuse mucosal thickening patterns, and shallow ulceration, as well as ulcerative type tumors in the small intestine [21]. The endoscopic ndings of GI-involved acute type ATLL showed super cial spreading-type lesions (equal to the diffuse in ltrating type) in 12 of 23 lesions (52%) [22].…”