Case Report of a Rapidly Progressive Indolent T-Cell Lymphoma of the Gastrointestinal Tract.
This case report emphasizes that indolent T-cell lymphoma of the gastrointestinal tract can lead to rapid clinical decline, as seen in an 85-year-old female who died 5 months after symptom onset.
Where it sits
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This case report describes an 85-year-old female with indolent T-cell lymphoma of the gastrointestinal tract (iTCL-GI) who presented with chronic diarrhea and weight loss. Balloon-assisted enteroscopy revealed multiple ulcerative lesions in the distal ileum, leading to a diagnosis of iTCL-GI. The patient received palliative care and died 5 months after symptom onset.
Abstract
Indolent T-cell lymphoma of the gastrointestinal tract (iTCL-GI) is a relatively newly recognized disease entity. iTCL-GI was first proposed by Perry et al. in 2013, before it was formally incorporated as a distinct disease category in the fifth edition of the World Health Organization Classification of Hematolymphoid Tumors: Lymphoid Neoplasms in 2022. Although the prognosis of iTCL-GI is generally favorable, some cases may present with malignant transformation or severe clinical manifestations. Herein, we describe a case of iTCL-GI with a poor clinical outcome. An 85-year-old female presented with chronic diarrhea and weight loss. Esophagogastroduodenoscopy and colonoscopy performed at the referring clinic were nondiagnostic, and the patient was referred to our institution. Balloon-assisted enteroscopy revealed multiple ulcerative lesions in the distal ileum, which were eventually diagnosed as iTCL-GI based on the biopsy findings. Palliative care was provided in accordance with the patient's preferences. Her gastrointestinal symptoms progressed rapidly, and she died 5 months after symptom onset. In this report, we discuss how balloon-assisted enteroscopy can be useful in the diagnosis of iTCL-GI, as well as a review of the literature on potential risk factors for poor clinical outcomes, including the presence of ulcers on endoscopy.
Background
Indolent T-cell lymphoma of the gastrointestinal tract (iTCL-GI) is a relatively newly recognized disease entity, first proposed in 2013 and classified in 2022. Prior knowledge indicates that while the prognosis is generally favorable, some cases may exhibit malignant transformation or severe clinical manifestations. This case report is significant as it highlights a poor clinical outcome in an elderly patient, raising questions about the variability in disease progression.
Methods
This is a case report detailing the clinical presentation and diagnostic process of an 85-year-old female patient. The patient underwent balloon-assisted enteroscopy after initial nondiagnostic endoscopic evaluations. The primary outcome was the diagnosis of iTCL-GI confirmed by biopsy findings.
Results
The patient was diagnosed with iTCL-GI following balloon-assisted enteroscopy, which revealed multiple ulcerative lesions. The patient's gastrointestinal symptoms progressed rapidly, leading to her death 5 months after symptom onset.
Interpretation
This case illustrates the potential for rapid disease progression in iTCL-GI, contrasting with the generally favorable prognosis reported in the literature. The findings underscore the need for careful monitoring in patients with gastrointestinal symptoms and highlight the role of balloon-assisted enteroscopy in diagnosis. However, the absence of a control group and the single-case nature of the report limit the conclusions that can be drawn regarding the generalizability of these findings.
Key findings
- Patient presented with chronic diarrhea and weight loss.
- Balloon-assisted enteroscopy revealed multiple ulcerative lesions in the distal ileum.
- Patient died 5 months after symptom onset.
Limitations
- Single case report, limiting generalizability.
- No statistical analysis or control group.
- Short follow-up period of 5 months.