December 2020 — Hematopathology
A 73 year old male with no underlying illness presented with watery diarrhea, bloating and intermittent abdominal pain. He was initially scheduled to have colonoscopy; however, he developed bowel perforation which required an exploratory laparotomy. A segment of the small bowel was resected.
What is the most likely diagnosis?
- Enteropathy-associated T-cell lymphoma
- Inflammatory bowel disease
- Monomorphic epitheliotropic intestinal T-cell lymphoma
- Indolent T-cell lymphoproliferative disorder of the gastointesinal tract
The correct answer is...
The correct answer is Monomorphic epitheliotropic intestinal T-cell lymphoma
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a primary intestinal T-cell lymphoma derived from the intraepithelial lymphocytes. Unlike enteropathy associated T-cell lymphoma, it is not associated with celiac disease and lacks an inflammatory background. The neoplastic cells have medium-sized nuclei with disepersed chromatin and moderate pale eosinophilic to clear cytoplasm. Epitheliotropism is usually prominent. MEITL has a distinctive phenotype with positive expression for CD3, CD8 and CD56 and is usually T-cell receptor (TCR) gamma-delta derived. MEITL prognosis is poor with a median survival of 7 months.
1. Swerdlow SH, Campo E, Harris NL, eds. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon, France: IARC; 2017.
|Majd Jawad, M.D.
|Adam Wood, D.O.
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science