Monomorphic epitheliotropic intestinal T-cell lymphoma presenting as melena with long-term survival: A case report and review of literature

doi:10.3748/wjg.v27.i38.6501

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World Journal of Gastroenterology

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Case Report

World J Gastroenterol. Oct 14, 2021; 27(38): 6501-6510
Published online Oct 14, 2021. doi: 10.3748/wjg.v27.i38.6501

Monomorphic epitheliotropic intestinal T-cell lymphoma presenting as melena with long-term survival: A case report and review of literature

Sotaro Ozaka, Kunimitsu Inoue, Tomoya Okajima, Takako Tasaki, Shimpei Ariki, Hideki Ono, Takeaki Ando, Tsutomu Daa, Kazunari Murakami

Sotaro Ozaka, Shimpei Ariki, Kazunari Murakami, Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5593, Japan

Kunimitsu Inoue, Tomoya Okajima, Takako Tasaki, Hideki Ono, Department of Gastroenterology, Almeida Memorial Hospital, Oita 870-1195, Japan

Takeaki Ando, Department of Hematology, Almeida Memorial Hospital, Oita 870-1195, Japan

Tsutomu Daa, Department of Diagnostic Pathology, Oita University, Oita 879-5593, Japan

Author contributions: Ozaka S cared for the patient, performed endoscopic treatment, and wrote and corrected the manuscript; Inoue K, Okajima T, Tasaki T, Ariki S, and Ono H cared for the patient and reviewed and corrected the manuscript; Daa T interpreted the pathological findings and contributed to manuscript drafting; Ando T performed the chemotherapy and contributed to manuscript drafting; Murakami K provided oversight for the manuscript and revised it for important intellectual content; all authors issued final approval for the version to be submitted.

Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Sotaro Ozaka, MD, Staff Physician, Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Oita 879-5593, Japan. ozakaso@oita-u.ac.jp

Received: April 9, 2021
Peer-review started: April 9, 2021
First decision: May 24, 2021
Revised: June 1, 2021
Accepted: September 6, 2021
Article in press: September 6, 2021
Published online: October 14, 2021
Processing time: 185 Days and 16.9 Hours

Abstract

BACKGROUND

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare primary intestinal T-cell lymphoma, previously known as enteropathy-associated T-cell lymphoma type II. MEITL is an aggressive T-cell lymphoma with a poor prognosis and high mortality rate. The known major complications of MEITL are intestinal perforation and obstruction. Here, we present a case of MEITL that was diagnosed following upper gastrointestinal bleeding from an ulcerative duodenal lesion, with recurrence-free survival for 5 years.

CASE SUMMARY

A 68-year-old female was admitted to our hospital with melena and mild anemia. An urgent esophagogastroduodenoscopy (EGD) revealed bleeding from an ulcerative lesion in the transverse part of the duodenum, for which hemostatic treatment was performed. MEITL was diagnosed following repeated biopsies of the lesion, and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy was administered. She achieved complete remission after eight full cycles of CHOP therapy. At the last follow-up examination, EGD revealed a scarred ulcer and ¹⁸Fluorodeoxyglucose (¹⁸FDG) positron emission tomography/computed tomography showed no abnormal FDG accumulation. The patient has been in complete remission for 68 mo after initial diagnosis.

CONCLUSION

To rule out MEITL, it is important to carefully perform histological examination when bleeding from a duodenal ulcer is observed.

Keywords: Monomorphic epitheliotropic intestinal T-cell lymphoma; Enteropathy-associated T-cell lymphoma type II; Gastrointestinal bleeding; Intestinal lymphoma; Duodenal ulcer; Case report

Core Tip: Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a primary intestinal T-cell lymphoma with the known major complications of intestinal perforation and obstruction. We experienced a case of MEITL that was diagnosed after gastrointestinal bleeding from an ulcerative duodenal lesion, who survived for a long time after treatment. MEITL can present as gastrointestinal bleeding. In addition, although MEITL has a poor prognosis, patients with MEITL might survive for a long time if effective treatment is administered at an early stage. Therefore, it is important to perform thorough histological examination for the early diagnosis of MEITL in cases with bleeding duodenal ulcers.