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

Figure 1 Endoscopic images and abdominal contrast-enhanced computed tomography scan images on initial examination. A: Esophagogastroduodenoscopy showed an ulcerative lesion with fresh blood clots in the transverse part of the duodenum; B: Contrast-enhanced computed tomography scan showed a slight localized contrast effect on the wall of the transverse part of the duodenum (arrow); C: When the blood clots were removed, a protruding vessel was observed at the base of the ulcer (arrow).

Figure 2 Histological and immunohistochemical analyses. A: Hematoxylin-eosin staining showed infiltration of medium-size atypical lymphoid cells in the mucosa; B: Lymphoid cell infiltration was also observed in the epithelium (arrow); C: Lymphoid cells expressed CD3; D: The lymphoid cells were CD8 negative; E: Lymphoid cells were CD56 positive. Magnification 200× (A, C-E) and 400× (B).

Figure 3 Pre-treatment ¹⁸Fluorodeoxyglucose positron emission tomography/computed tomography images. ¹⁸Fluorodeoxyglucose positron emission tomography/computed tomography showed abnormal nodular accumulation in the wall of the transverse part of the duodenum (arrow).

Figure 4 Follow-up endoscopic examinations. A: Esophagogastroduodenoscopy (EGD) after three cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone therapy revealed that the ulcerative lesion had clearly reduced in size; B: EGD performed 60 mo after complete remission showed a scarred ulcer.

Figure 5 Follow-up ¹⁸Fluorodeoxyglucose positron emission tomography/computed tomography at 60 mo after complete remission. ⁸Fluorodeoxyglucose positron emission tomography/computed tomography showed no abnormal fluorodeoxyglucose accumulation.