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Love J, Raza H, Kheirkhah P, Ghoulam E, Thaker S, Carroll R. Primary Gastrointestinal T-cell Lymphoma Presenting as Spontaneous Perforation Peritonitis. Cureus 2023; 15:e35028. [PMID: 36938190 PMCID: PMC10023136 DOI: 10.7759/cureus.35028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
Primary T-cell non-Hodgkin lymphoma (NHL) of the gastrointestinal tract (GIT) is a rare, poorly-characterized clinical entity. A well-known complication of intestinal NHL is perforation due to chemotherapy, but perforation as a presenting sign of GIT lymphoma is extremely rare. Here we present a case of spontaneous intestinal perforation secondary to primary intestinal T-cell lymphoma and highlight the importance of early recognition of this uncommon cause of perforation as a crucial step to ensure expedited hematology referral and initiation of appropriate treatment.
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Affiliation(s)
- James Love
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Hasan Raza
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | | | - Elie Ghoulam
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Sarang Thaker
- Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Robert Carroll
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, USA
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Yang H, Zhang H, Liu W, Tan B, Guo T, Gao X, Feng R, Wu K, Cao Q, Ran Z, Liu Z, Hu N, Zhu L, Lai Y, Wang C, Han W, Qian J. Differential Diagnosis of Crohn’s Disease and Ulcerative Primary Intestinal Lymphoma: A Scoring Model Based on a Multicenter Study. Front Oncol 2022; 12:856345. [PMID: 35586498 PMCID: PMC9108901 DOI: 10.3389/fonc.2022.856345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Differential diagnosis of Crohn’s disease (CD) and ulcerative primary intestinal lymphoma (UPIL) is a tough problem in clinical practice. Aims Our study identified key differences between CD and UPIL patients and aimed to further establish a scoring model for differential diagnosis. Methods A total of 91 CD and 50 UPIL patients from 9 tertiary inflammatory bowel disease centers were included. Univariate and multivariate analyses were used to determine significant markers for differentiating CD and UPIL. A differential scoring model was established by logistic regression analysis. Results The differential model was based on clinical symptoms, endoscopic and imaging features that were assigned different scores: intestinal bleeding (−2 points), extraintestinal manifestation (2 points), segmental lesions (1 point), cobblestone sign (2 points), homogeneous enhancement (−1 point), mild enhancement (−1 point), engorged vasa recta (1 point). A total score of ≥1 point indicates CD, otherwise UPIL was indicated. This model produced an accuracy of 83.66% and an area under the ROC curve of 0.947. The area under the ROC curve for validation using the 10-fold validation method was 0.901. Conclusion This study provided a convenient and useful model to differentiate CD from UPIL.
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Affiliation(s)
- Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huimin Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bei Tan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Gao
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui Feng
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kaichun Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Zhihua Ran
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health; Shanghai Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhanju Liu
- Department of Gastroenterology, The Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Naizhong Hu
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liangru Zhu
- Department of Gastroenterology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yamin Lai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congling Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, School of Basic Medicine, Beijing, China
- *Correspondence: Jiaming Qian, ; Wei Han,
| | - Jiaming Qian
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Jiaming Qian, ; Wei Han,
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Panneerselvam K, Goyal S, Shirwaikar Thomas A. Ileo-colonic lymphoma: presentation, diagnosis, and management. Curr Opin Gastroenterol 2021; 37:52-58. [PMID: 33105251 DOI: 10.1097/mog.0000000000000687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The gut-associated lymphoid tissue (GALT), the bulk of which is located in the ileo-colonic region comprises the lymphoid cells of the gastrointestinal tract and confers specific immunological responses. Repetitive antigenic stimulation of these cells predispose to a monoclonal proliferation of this tissue and the eventual development of lymphoma. The gastrointestinal tract is the most commonly involved site of extranodal lymphomas. This review will focus primarily on lymphomas of the ileo-colonic region (defined as the terminal ileum, the colon, and the rectum). We will discuss the epidemiology, pathogenesis, and presentation as well as current practices in diagnosis and management. RECENT FINDINGS Despite the majority of the GALT to be located in the ileo-colonic region of the gut, the lymphomas in this location are relatively rare. However, the overall annual incidence of ileo-colonic lymphomas is steadily increasing. This entity has a varied spectrum of clinical presentations. Ileo-colonoscopy with adequate targeted biopsies can serve as a gold standard for definitive diagnosis. Ileo-colonic lymphomas may be managed with chemotherapy alone while surgery is reserved for highly aggressive tumors or clinical emergencies. Radiation is not a preferred adjuvant treatment for lymphomas in this location of the gut. Adequate endoscopic surveillance measures and tools to potentially prevent recurrence and improve the overall prognosis of this disease are lacking. SUMMARY Ileo-colonic lymphomas are rare and can present with varied symptoms and signs. Endoscopy with adequate sampling can aid in making a definitive diagnosis. Chemotherapy can be highly effective in management while surgery is indicated for emergency presentations. Adequate endoscopic surveillance tools are lacking, yet imperative to prevent recurrence and improve prognosis.
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Affiliation(s)
| | - Shreya Goyal
- Department of Internal Medicine, Baylor College of Medicine
| | - Anusha Shirwaikar Thomas
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Qian J, Meng H, Lv B, Wang J, Lu Y, Li W, Zhao S. TLR9 expression is associated with PD-L1 expression and indicates a poor prognosis in patients with peripheral T-cell lymphomas. Pathol Res Pract 2019; 216:152703. [PMID: 31879046 DOI: 10.1016/j.prp.2019.152703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/06/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
Toll-like receptor9 (TLR9), a member of pattern recognition receptors, play an important role in tumor immunologic surveillance. However, the clinical impact of TLR9 and programmed cell death-ligand 1 (PD-L1) in peripheral T-cell lymphomas (PTCL) remains unclear. In this study, we examined the expression of TLR9 and PD-L1 by immunohistochemical staining in patients with PTCL, and evaluated the clinical significance between expression and clinicopathological features. We found that the rates of high expression of TLR9 and PD-L1 on tumor cells were 65.3% and 45.8% in PTCL, respectively. TLR9 expression was associated with PD-L1 expression in PTCL. Moreover, TLR9 expression was associated with gender, ECOG score, Ki-67 expression, while PD-L1 expression was associated with the number of extranodal involvement and platelet count. High expression of either TLR9 or PD-L1 indicated a poor survival rate for patients with PTCL. Multivariate analysis confirmed that high expression of TLR9 and PD-L1 were unfavorable prognostic factors for patients with PTCL. Thus, TLR9 and PD-L1 expression might be important on the point of prognostic markers in PTCL.
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Affiliation(s)
- Jingrong Qian
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, PR China
| | - Hongxue Meng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, PR China
| | - Bowen Lv
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, PR China
| | - Jie Wang
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, PR China
| | - Yingying Lu
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, PR China
| | - Wenhui Li
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, PR China.
| | - Shu Zhao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, PR China.
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Kim JY, Chang SH, Kim HS, Joo M. Diffuse Involvement of Primary Colorectal Lymphoma Simulating Ulcerative Colitis. J Pathol Transl Med 2019; 53:332-336. [PMID: 31370383 PMCID: PMC6755650 DOI: 10.4132/jptm.2019.07.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/12/2019] [Indexed: 11/17/2022] Open
Abstract
Diffuse involvement of colorectal lymphoma masquerading as colitis is a very rare presentation of primary colorectal lymphoma. Detecting occult lymphoma is difficult in the setting of diffuse colonic involvement with no definite mass and inflammatory mucosal changes. We encountered a case of diffuse-type primary colorectal lymphoma simulating ulcerative colitis in a previously healthy 31-year-old woman. Despite multiple mucosal biopsies, the biopsy diagnosis was not made due to unawareness of atypical lymphocytes admixed with dense lymphoplasmacytic infiltration. The present case emphasizes the importance of being aware of this rare presentation of primary colorectal lymphoma in order to avoid misdiagnosis.
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Affiliation(s)
- Ji-Ye Kim
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun Hee Chang
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Han Seong Kim
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Mee Joo
- Department of Pathology, Inje University Ilsan Paik Hospital, Goyang, Korea
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Gentille C, Qin Q, Barbieri A, Ravi PS, Iyer S. Use of PEG-asparaginase in monomorphic epitheliotropic intestinal T-cell lymphoma, a disease with diagnostic and therapeutic challenges. Ecancermedicalscience 2017; 11:771. [PMID: 29062389 PMCID: PMC5636209 DOI: 10.3332/ecancer.2017.771] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Indexed: 12/14/2022] Open
Abstract
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), previously known as enteropathy associated T-cell lymphoma (EATL) type II, is a rare haematological malignancy with a difficult and delayed diagnosis. Symptoms can include abdominal pain, weight loss, and chronic diarrhoea. However, most patients are only diagnosed after complications, such as perforation or obstruction, have developed. There is no standard treatment for MEITL; most accepted regimens consist of surgical resection and anthracycline-based chemotherapy. Prognosis is poor with an approximate survival of less than a year. Even though other therapies, such as autologous stem cell transplant, has shown promising results, not all patients can tolerate this course of treatment especially if they are elderly, have several comorbidities or are malnourished. Innovative therapies that improve survival and can be used as an alternative for more intensive treatment are needed. We report the use of PEG-asparaginase along with conventional anthracycline therapy in a 70-year-old woman diagnosed with MEITL, who went into remission and survived for more than one year before succumbing to relapsed disease.
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Affiliation(s)
- Cesar Gentille
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas 77030, USA
| | - Qian Qin
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas 77030, USA
| | - Andreia Barbieri
- Department of Pathology, Houston Methodist Hospital, Houston, Texas 77030, USA
| | - Pingali Sai Ravi
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, Texas 77030, USA
| | - Swaminathan Iyer
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, Texas 77030, USA
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Mamachen A, Al-Hanayneh M, Bilal M, Merwat S, Hashmi A. Eosinophilic Colitis-"Not as rare". Dig Liver Dis 2017; 49:826-828. [PMID: 28546064 DOI: 10.1016/j.dld.2017.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Ashish Mamachen
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.
| | - Muhannad Al-Hanayneh
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States; Division of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston, TX, United States
| | - Mohammad Bilal
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States; Division of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston, TX, United States
| | - Shehzad Merwat
- Division of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston, TX, United States
| | - Ali Hashmi
- Division of Gastroenterology & Hepatology, University of Texas Medical Branch, Galveston, TX, United States
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