单形性嗜上皮性肠T细胞淋巴瘤致反复消化道出血1例

上海交通大学学报（医学版）

• •

单形性嗜上皮性肠T细胞淋巴瘤致反复消化道出血1例

胡泽玉¹(), 周铖², 杨林³, 马晓燕⁴, 肖海娟⁵(), 司海龙⁵

^1.陕西中医药大学第一临床医学院，咸阳 712046
^2.河南中医药大学第一临床医学院，郑州 450046
^3.陕西省咸阳市中心医院肝胆外科，咸阳 712000
^4.陕西省咸阳市中心医院病理科，咸阳 712000
^5.陕西中医药大学附属医院肿瘤内科，咸阳 712000

收稿日期:2022-07-08 接受日期:2022-10-21 出版日期:2022-12-20 发布日期:2022-12-20
通讯作者: 肖海娟 E-mail:549643140@qq.com;daisytcm@hotmail.com
作者简介:胡泽玉（1997—），女，硕士生；电子信箱：549643140@qq.com。
基金资助:
陕西省自然科学基金青年项目(2018JQ8014);陕西中医药大学创新团队(2019-YL06)

Monomorphic epitheliotropic intestinal T-cell lymphoma: a case with recurrent gastrointestinal hemorrhage

HU Zeyu¹(), ZHOU Cheng², YANG Lin³, MA Xiaoyan⁴, XIAO Haijuan⁵(), SI Hailong⁵

^1.First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang 712046, China
^2.First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou 450046, China
^3.Department of Hepatobiliary Surgery, Xianyang Central Hospital in Shaanxi Province, Xianyang 712000, China
^4.Department of Pathology, Xianyang Central Hospital in Shaanxi Province, Xianyang 712000, China
^5.Department of Oncology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, China

Received:2022-07-08 Accepted:2022-10-21 Online:2022-12-20 Published:2022-12-20
Contact: XIAO Haijuan E-mail:549643140@qq.com;daisytcm@hotmail.com
Supported by:
Natural Science Foundation Youth Project of Shaanxi Province(2018JQ8014);Subject Innovation Team of Shaanxi University of Chinese Medicine(2019-YL06)

摘要/Abstract

摘要：

患者，男，63岁，因“间断性黑便1月余，加重7 h”于2019年9月4日至陕西省咸阳市中心医院就诊，以“消化道出血”收治入院。入院时有鲜血便，量多，伴腹痛、腹胀、头晕、乏力、纳差，无其他明显特殊不适。入院后行电子胃镜检查，考虑慢性非萎缩性胃炎伴糜烂；电子结肠镜检查考虑回盲瓣炎；胶囊内镜检查考虑溃疡及肿瘤可能；单气囊小肠镜检查及组织活检证实为单形性嗜上皮性肠T细胞淋巴瘤（monomorphic epitheliotropic intestinal T-cell lymphoma，MEITL）。2019年11月8日患者转院至陕西中医药大学附属医院肿瘤内科；采用R-CHOP方案（利妥昔单抗联合环磷酰胺、阿霉素、长春新碱、泼尼松）化学治疗（化疗）2个周期后，疾病出现进展；化疗方案更换为DA-EPOCH方案（依托泊苷、泼尼松、长春新碱、环磷酰胺和阿霉素）。规范化治疗4个月后，患者病情再次加重，放弃治疗后出院，于2020年3月20日死亡。MEITL因其侵袭性强、恶化程度高、肿瘤负荷重、难确诊及易误诊的特点，患者往往预后不佳，死亡率极高。该文对该例MEITL患者的临床资料进行报道，旨在为后续同类症状患者的诊断和治疗提供参考。

网络首发地址：https://kns.cnki.net/kcms/detail//31.2045.R.20221216.1559.003.html

网络首发时间：2022-12-20 08:51:11

Abstract:

A male patient, 63-year-old, went to Xianyang Central Hospital in Shaanxi Province on September 4, 2019, for "intermittent black stool for more than 1 month with aggravation for 7 h", and was admitted as "gastrointestinal bleeding". On admission, there was fresh blood stool with a large amount, accompanied by abdominal pain, abdominal distension, dizziness, fatigue, and anorexia, without other obvious special discomfort. The electrogastroscopy indicated chronic non-atrophic gastritis with erosion; the electron colonoscopy indicated ileocecal valve inflammation; the capsule endoscopy indicated ulcer and tumor possibility. The patient was finally diagnosed as having monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) after single balloon small bowel microscopy and pathological biopsy. On November 8, 2019, the patient was transferred to the Department of Oncology, Affiliated Hospital of Shaanxi University of Chinese Medicine. After 2 cycles of chemotherapy with R-CHOP regimen (rituximab combined with cyclophosphamide, adriamycin, vincristine and prednisone), the disease progressed and then the therapy was replaced with DA-EPOCH regimen (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin). After 4 months of standardized treatment, the patient′s condition worsened again; he left hospital after giving up treatment, and died on March 20, 2020. MEITL has the characteristics of strong invasiveness, high degree of deterioration, heavy tumor load, difficult diagnosis and easy misdiagnosis, so the patients often have poor prognosis and high mortality. This article reports the clinical data of this patient with MEITL, aiming to provide reference for the diagnosis and treatment of patients with similar symptoms.

Key words: enteropathy-associated T-cell lymphoma (EATL), monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), gastrointestinal hemorrhage

中图分类号:

R733.4

胡泽玉, 周铖, 杨林, 马晓燕, 肖海娟, 司海龙. 单形性嗜上皮性肠T细胞淋巴瘤致反复消化道出血1例[J]. 上海交通大学学报（医学版）.

HU Zeyu, ZHOU Cheng, YANG Lin, MA Xiaoyan, XIAO Haijuan, SI Hailong. Monomorphic epitheliotropic intestinal T-cell lymphoma: a case with recurrent gastrointestinal hemorrhage[J]. Journal of Shanghai Jiao Tong University (Medical Science).

图/表 4

图1 胶囊内镜检查空肠段图像Note： In spite of the poor intestinal preparation of the jejunal segment, multiple deep basal depressions were visible.

Fig 1 The image of capsule endoscopy in the jejunal segment

图2 单气囊小肠镜检查空肠段图像Note： A large lamellar ulcerative lesion in the upper jejunum.

Fig 2 The image of single-balloon enteroscope in the jejunal segment

图3 患者空肠活检样本组织学观察 (H-E染色)Note： A. The jejunum mucosa was infiltrated with lymphocytes (×100). B. Some of the lymphocytes were medium in size with lightly stained cytoplasm, obvious nucleoli, and mitotic figures (×400).

Fig 3 Histological observation of the patient′s jejunum biopsy samples (H-E staining)

图4 患者空肠活检样本的免疫组织化学染色 (×100)Note： A. CD3. B. CD56. C. CD8. D. Ki-67 (Ki-67 index of 80%).

Fig 4 Immunohistochemical staining of the patient′s jejunum biopsy samples (×100)

参考文献 16

1	AL SOMALI Z, HAMADANI M, KHARFAN-DABAJA M, et al. Enteropathy-associated T cell lymphoma[J]. Curr Hematol Malig Rep, 2021, 16(2): 140-147.
2	张旭, 董菲, 田磊, 等. 单形性嗜上皮性肠道T细胞淋巴瘤11例临床分析[J]. 中国微创外科杂志, 2022, 22(3): 232-236.
	ZHANG X, DONG F, TIAN L, et al. Clinical analysis of 11 cases of monomorphic epitheliotropic intestinal T-cell lymphoma[J]. Chinese Journal of Minimally Invasive Surgery, 2022, 22(3): 232-236.
3	JAFFE E S. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research[J]. Hematology Am Soc Hematol Educ Program, 2009: 523-531.
4	SWERDLOW S H, CAMPO E, PILERI S A, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127(20): 2375-2390.
5	TOMITA S, KIKUTI Y Y, CARRERAS J, et al. Genomic and immunohistochemical profiles of enteropathy-associated T-cell lymphoma in Japan[J]. Mod Pathol, 2015, 28(10): 1286-1296.
6	ONDREJKA S, JAGADEESH D. Enteropathy-associated T-cell lymphoma[J]. Curr Hematol Malig Rep, 2016, 11(6): 504-513.
7	杨晓俊, 候宁, 史传兵. 单形性亲上皮性肠道T细胞淋巴瘤的病理学特征及MATK表达的诊断价值[J]. 东南大学学报(医学版), 2022, 41(2): 250-255.
	YANG X J, HOU N, SHI C B. Pathological features and diagnostic value of the expression of MATK in monomorphic epitheliotropic intestinal T-cell lymphoma[J]. Journal of Southeast University (Medical Science Edition), 2022, 41(2): 250-255.
8	MONTES-MORENO S, KING R L, OSCHLIES I, et al. Update on lymphoproliferative disorders of the gastrointestinal tract: disease spectrum from indolent lymphoproliferations to aggressive lymphomas[J]. Virchows Arch, 2020, 476(5): 667-681.
9	SABATTINI E, BACCI F, SAGRAMOSO C, et al. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview[J]. Pathologica, 2010, 102(3): 83-87.
10	GALE J, SIMMONDS P D, MEAD G M, et al. Enteropathy-type intestinal T-cell lymphoma: clinical features and treatment of 31 patients in a single center[J]. J Clin Oncol, 2000, 18(4): 795-803.
11	HORWITZ S M, ANSELL S, AI W Z, et al. NCCN guidelines insights: T-cell lymphomas, version 1.2021[J]. J Natl Compr Canc Netw, 2020, 18(11): 1460-1467.
12	YI J H, LEE G W, DO Y R, et al. Multicenter retrospective analysis of the clinicopathologic features of monomorphic epitheliotropic intestinal T-cell lymphoma[J]. Ann Hematol, 2019, 98(11): 2541-2550.
13	SIENIAWSKI M, ANGAMUTHU N, BOYD K, et al. Evaluation of enteropathy-associated T-cell lymphoma comparing standard therapies with a novel regimen including autologous stem cell transplantation[J]. Blood, 2010, 115(18): 3664-3670.
14	赵东陆, 马军. T细胞淋巴瘤治疗进展[J]. 白血病·淋巴瘤, 2017, 26(8): 449-451.
	ZHAO D L, MA J. Progress of T-cell lymphoma treatment[J]. Journal of Leukemia and Lymphoma, 2017, 26(8): 449-451.
15	VOORHEES T J, GHOSH N, GROVER N, et al. Long-term remission in multiply relapsed enteropathy-associated T-cell lymphoma following CD30 CAR T-cell therapy[J]. Blood Adv, 2020, 4(23): 5925-5928.
16	宋双双, 于澜, 周晓明, 等. 原发性肠道T细胞淋巴瘤CT小肠造影的影像特点及其诊断价值[J]. 中国医学影像技术, 2017, 33(7): 1010-1013.
	SONG S S, YU L, ZHOU X M, et al. Diagnostic value and characteristics of CT enterography in primary intestinal T-cell lymphoma[J]. Chinese Journal of Medical Imaging Technology, 2017, 33(7): 1010-1013.

单形性嗜上皮性肠T细胞淋巴瘤致反复消化道出血1例

Monomorphic epitheliotropic intestinal T-cell lymphoma: a case with recurrent gastrointestinal hemorrhage

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 16

相关文章 1

编辑推荐

Metrics