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.

H&E x 4
H&E x 40
CD3 x4
CD8 x4
CD56 x 4
TCR-Delta X4

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.​

Photo of Majd Jawad, M.D. Majd Jawad, M.D.
Resident, Hematopathology
Mayo Clinic
Photo of Adam Wood, D.O. Adam Wood, D.O.
Consultant, Hematopathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

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