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Horwitz SM, Ansell S, Ai WZ, Barnes J, Barta SK, Brammer J, Clemens MW, Dogan A, Foss F, Ghione P, Goodman AM, Guitart J, Halwani A, Haverkos BM, Hoppe RT, Jacobsen E, Jagadeesh D, Jones A, Kallam A, Kim YH, Kumar K, Mehta-Shah N, Olsen EA, Rajguru SA, Rozati S, Said J, Shaver A, Shea L, Shinohara MM, Sokol L, Torres-Cabala C, Wilcox R, Wu P, Zain J, Dwyer M, Sundar H. T-Cell Lymphomas, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:285-308. [PMID: 35276674 DOI: 10.6004/jnccn.2022.0015] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of lymphoproliferative disorders arising from mature T cells, accounting for about 10% of non-Hodgkin lymphomas. PTCL-not otherwise specified is the most common subtype, followed by angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma, anaplastic lymphoma kinase-positive, anaplastic large cell lymphoma, anaplastic lymphoma kinase-negative, and enteropathy-associated T-cell lymphoma. This discussion section focuses on the diagnosis and treatment of PTCLs as outlined in the NCCN Guidelines for T-Cell Lymphomas.
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Affiliation(s)
| | | | - Weiyun Z Ai
- 3UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stefan K Barta
- 5Abramson Cancer Center at the University of Pennsylvania
| | - Jonathan Brammer
- 6The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | - Joan Guitart
- 11Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ahmad Halwani
- 12Huntsman Cancer Institute at the University of Utah
| | | | | | | | - Deepa Jagadeesh
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Allison Jones
- 17St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Kiran Kumar
- 19UT Southwestern Simmons Comprehensive Cancer Center
| | - Neha Mehta-Shah
- 20Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Sima Rozati
- 23The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Michi M Shinohara
- 27Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Ryan Wilcox
- 29University of Michigan Rogel Cancer Center
| | - Peggy Wu
- 30UC Davis Comprehensive Cancer Center
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Mourad AP, De Robles MS, Winn RD. Intestinal T-cell lymphoma presenting as colonic perforation in the setting of ulcerative colitis: a case report. Clin J Gastroenterol 2020; 14:176-180. [PMID: 33174156 DOI: 10.1007/s12328-020-01279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
The intestinal T-cell lymphomas are a rare group of lymphatic malignancies arising from the gastrointestinal tract. They frequently manifest with non-specific clinical and radiographic findings that may mimic several other disease processes. The most common subtype is linked with refractory coeliac disease and commonly affects the small intestine. We report a case where the diagnosis was uncovered endoscopically in a patient presenting with colonic perforation on a background of long-standing ulcerative colitis. Surgical source control was required prior to considering chemotherapy, which is the usual treatment option in lymphatic malignancies. The case highlights the importance endoscopic evaluation in inflammatory conditions of the colon.
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Affiliation(s)
- Ali Phillip Mourad
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia.
| | - Marie Shella De Robles
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia
| | - Robert Duncan Winn
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia
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Abstract
There are a number of rare T-cell lymphoma subtypes that may be encountered in clinical practice. In recent years, improved immunohistochemical techniques and molecular tumor profiling have permitted refinement of some of the diagnostic categories in this group, as well as the recognition of distinct conditions not previously well elucidated. In this chapter, we cover the diagnostic and clinical features of some of the more common of these conditions, including subcutaneous panniculitis-like T-cell lymphoma, cutaneous gamma-delta T-cell lymphoma, enteropathy-associated T-cell lymphoma, monomorphic epitheliotropic intestinal T-cell lymphoma, primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma, CD4-positive small/medium T-cell lymphoproliferative disorder, and acral CD8-positive T-cell lymphoma. Given the rarity of these conditions, optimal treatments approaches are not always well established, not least as data from large-scale clinical trials are lacking. In this chapter, we aim to provide a summation of current thinking around best treatment, as well as highlighting some controversies in the management of these diagnoses.
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Affiliation(s)
- C van der Weyden
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - C McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Dermatology, St Vincent's Hospital, Fitzroy, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
| | - S Lade
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - R W Johnstone
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H M Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Epworth Healthcare, Melbourne, Australia
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Agah S, Ghavam R, Darvishi Zeidabadi A, Sarveazad A. Unusual Cause of Dysphagia. Middle East J Dig Dis 2017; 9:58-59. [PMID: 28316768 PMCID: PMC5308137 DOI: 10.15171/mejdd.2016.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shahram Agah
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ramak Ghavam
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
Type II enteropathy-associated T-cell lymphoma (EATL) is a rare disease that is reported from Asia, especially from Taiwan. In this paper, we present a patient from Iran (Arab) with Type II EATL whose disease was not associated with celiac disease or Epstein-Barr virus (EBV) infection. The patient died due to intestinal perforation during the first chemotherapy. Type II EATL is a gastrointestinal lymphoma with poor prognosis and a high affinity for intestinal perforation. Early detection of EATL II is essential for chemotherapy prior to the onset of malnutrition symptoms.
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Affiliation(s)
- Neda Nozari
- Researcher, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Shahid Rajai Hospital, Alborz University of Medical Sciences, Karaj, Iran
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Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011; 17:697-707. [PMID: 21390139 PMCID: PMC3042647 DOI: 10.3748/wjg.v17.i6.697] [Citation(s) in RCA: 235] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific, thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.
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van de Water JMW, Cillessen SAGM, Visser OJ, Verbeek WHM, Meijer CJLM, Mulder CJJ. Enteropathy associated T-cell lymphoma and its precursor lesions. Best Pract Res Clin Gastroenterol 2010; 24:43-56. [PMID: 20206108 DOI: 10.1016/j.bpg.2009.11.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 11/16/2009] [Indexed: 01/31/2023]
Abstract
Enteropathy Associated T-cell Lymphoma (EATL) is an intestinal tumour of intra-epithelial lymphocytes. Based on morphology, immunohistochemistry and genetic profile EATL can be divided into two groups. EATL type I is a large cell lymphoma which is highly associated with Coeliac Disease (CD) and mostly presents with malabsorption, weight loss and CD-related symptoms. EATL type II consists of small to medium-sized cells and presents often with obstruction or perforation of the small bowel. This type of EATL has no known association with CD. When EATL has been diagnosed a thorough diagnostic work-up is needed. This work-up preferably includes video capsule enteroscopy (VCE), double-balloon enteroscopy (DBE), computed tomography (CT) combined with 18F-fluorodeoxyglucose positron emission tomography scan (18F-FDG-PET scan) if possible and magnetic resonance enteroclysis (MRE). Nowadays, most EATL patients are treated with chemotherapy mostly preceded by resection of the tumour and followed by stem cell transplantation. Despite these therapies outcome of EATL remains very poor with a 5-year survival of 8-20%. In order to improve survival prospective multicentre trials, studying new therapies are needed. The combination of chemotherapy, monoclonal antibodies and/or apoptosis inducing small molecules might be a potential treatment for EATL in the (nearby) future.
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Affiliation(s)
- Jolanda M W van de Water
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands.
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