Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5781-5789
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5781
Early colon cancer with enteropathy-associated T-cell lymphoma involving the whole gastrointestinal tract: A case report
Meng-Yuan Zhang, Cong-Cong Min, Wei-Wei Fu, Hua Liu, Xiao-Yan Yin, Cui-Ping Zhang, Zi-Bin Tian, Xiao-Yu Li
Meng-Yuan Zhang, Cong-Cong Min, Hua Liu, Xiao-Yan Yin, Cui-Ping Zhang, Zi-Bin Tian, Xiao-Yu Li, Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Wei-Wei Fu, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Author contributions: Zhang MY and Min CC collected the clinical data and wrote the manuscript; Fu WW provided pathological pictures and contributed to pathological diagnosis; Liu H, Yin XY, and Zhang CP contributed to clinical data collection and follow-up; Tian ZB directed the study and reviewed the final manuscript; Li XY performed the endoscopic resection for the patient and revised the article.
Supported by National Natural Science Foundation of China, No. 81802777; Shandong Higher Education Research Center Scientific Research Project, No. YJKT201953; Shandong Province 2018 Professional Degree Postgraduate Teaching Case Library Project, No. SDYAL18049; Shandong Province 2018 Postgraduate Mentoring Ability Improvement Project, No. SDYY18073; and the "Clinical Medicine + X" Project of Qingdao University Hospital.
Informed consent statement: Informed written 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).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yu Li, MD, Associate Chief Physician, Department of Gastroenterology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266003, Shandong Province, China. lixiaoyu05@163.com
Received: August 13, 2020
Peer-review started: August 13, 2020
First decision: August 21, 2020
Revised: August 28, 2020
Accepted: September 11, 2020
Article in press: September 11, 2020
Published online: November 26, 2020
Processing time: 103 Days and 15.2 Hours
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: Enteropathy-associated T-cell lymphoma, Early colon cancer, Endoscopic mucosal resection, Case report, T-cell lymphoma, Diarrhea

Core Tip: Enteropathy-associated T-cell lymphoma (EATL) is a rare aggressive lymphoma of the gastrointestinal tract. We present the case of a male patient with chronic diarrhea for more than 5 mo, and colonoscopy showed multiple polyps with the pathology of early colonic cancer. Endoscopic mucosal resection was performed. Postoperative histopathological and immunohistochemistry results suggested EATL with moderately differentiated adenocarcinoma confined to the mucosa. This is a rare case of EATL involving the whole colon, duodenum, and small intestine, complicated with early colon cancer. Nonspecific clinical symptoms and typical endoscopy appearance pose difficulty in making an accurate diagnosis. More attention should be paid to the swollen colonic mucosa with a granular appearance in unexplained chronic diarrhea to avoid misdiagnosis.