Early colon cancer with enteropathy-associated T-cell lymphoma involving the whole gastrointestinal tract: A case report

Abstract

Background: Enteropathy-associated T-cell lymphoma (EATL) is a rare invasive lymphoma derived from gastrointestinal epithelial T lymphocytes. EATL involving the whole gastrointestinal tract accompanied with early colon cancer is extremely rare.

Case summary: We present the case of a 67-year-old man with diarrhea for more than 5 mo whose colonoscopy in another hospital showed multiple colonic polyps, which indicated moderate to severe dysplasia and focal early cancer. Therefore, he was referred to our hospital for further endoscopic treatment. Colonoscopy after admission showed that the mucosa of the terminal ileum and the entire colon were slightly swollen and finely granular. Endoscopic mucosal resection was performed for colonic polyps located in the liver flexure of the colon and descending colon, respectively. Histopathological findings revealed diffuse infiltration of medium-sized lymphoid cells in the colonic mucosa and visible lymphoepithelial lesions. The histopathology of the polyp in the descending colon indicated moderately differentiated adenocarcinoma limited to the mucosa with negative resection margins. Additionally, immunohistochemical analysis showed positive staining for CD7 and CD8. Therefore, we arrived at a diagnosis of EATL with early colon cancer. Subsequently, the patient was transferred to the hematology department for chemotherapy. The patient's diarrhea was not significantly relieved after receiving chemotherapy, and he ultimately died of severe myelosuppression.

Conclusion: EATL should be considered in unexplained chronic diarrhea. EATL progresses rapidly with a poor prognosis, especially when accompanied with early colon cancer.

Keywords: Case report; Diarrhea; Early colon cancer; Endoscopic mucosal resection; Enteropathy-associated T-cell lymphoma; T-cell lymphoma.

Figure 1

Chest and abdominal computed tomography showed rapid disease progression. A and B: Chest computed tomography (CT) on June 11, 2019 showed clear lung fields on both sides; C and D: Abdominal CT on June 11, 2019 showed a liver cyst, and part of a slightly dilated small intestine; E and F: Chest CT on May 31, 2020 revealed multiple nodules and masses in both lungs, not excluding neoplastic lesions (orange arrow); G and H: Abdominal CT on May 31, 2020 showed multiple low-density lesions in the right liver and multiple soft tissue masses in the abdominal cavity, suggesting multiple metastases (blue arrow).

Figure 2

Diffuse swelling and finely granular appearance of the terminal ileum and entire colon mucosa. A: The terminal ileum mucosa is swollen; B: The mucosa around the appendix opening is swollen; C: The mucosa around the ileocecal valve is finely granular; D: The mucosa of the ascending colon is diffusely finely granular; E: A polypoid lesion was observed in the liver curve of the colon, with a finely granular appearance on the surface; F: A long-pedicle polyp was found in the descending colon, with fine granular mucosal changes on the head and pedicle of the polyp; G: The sigmoid colon mucosa is finely granular; H: The rectal mucosa is swollen.

Figure 3

The whole gastric mucosa is swollen with flaky erosions in the angle and antrum of the stomach, and the mucosa of the stomach and descending duodenum is finely granular. A: The fundus mucosa is swollen; B: The angle of the stomach is rough and swollen; C: Flaky mucosal erythema in the gastric antrum; D: The mucosa of the duodenum is finely granular.

Figure 4

Pathology of the colon and duodenum A: Descending colon. Villous adenoma with focal carcinogenesis (moderately differentiated adenocarcinoma), limited to the mucosal layer, was observed (× 100); B: Descending colon. There was diffuse atypical lymphocyte proliferation with a single form mainly infiltrated in the mucosal epithelium and lamina propria, partly invading the submucosa (× 400); C: Duodenum. Several lymphocytes infiltrated in the mucosal layer (× 100); D: Duodenum. Atypical lymphocytes accumulated in the mucosal layer with medium-sized cell bodies consisting of few cytoplasm and large oval or irregular nucleus containing coarse chromatin (× 400).