Endoscopic Visualization of a Jejuno-Colonic Fistula in a Case of Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma.
In patients with significant weight loss and hypoalbuminemia, gastrointestinal fistula formation may indicate malignant lymphoma, including MEITL, warranting careful endoscopic examination.
Where it sits
this study against the rest of the semax corpusSummary and findings
This case report details an 83-year-old woman with monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) presenting with a jejunocolic fistula. The patient experienced a 20-kg weight loss and was found to have hypoalbuminemia and elevated inflammatory markers. Due to her poor condition, best supportive care was chosen, and she died on hospital Day 33.
Abstract
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare primary intestinal T-cell lymphoma newly defined in the 2016 WHO classification, characterized by rapid progression and a poor prognosis. Fistula formation caused by intestinal lymphoma is extremely uncommon, and no previous reports have described MEITL presenting with a jejunocolic fistula. An 83-year-old woman presented with a 20-kg weight loss and generalized fatigue over the preceding year. Laboratory tests revealed hypoalbuminemia and elevated inflammatory markers. Computed tomography demonstrated wall thickening of the jejunum and descending colon, suggesting possible continuity between the two segments. Colonoscopy revealed a circumferential ulcerative lesion at the splenic flexure, and proximal to this lesion, another lumen extending in a direction different from the colonic lumen was observed. Biopsy confirmed a diagnosis of MEITL. Positron emission tomography-computed tomography (PET-CT) showed abnormal FDG uptake from the jejunum to the transverse colon, and the disease was classified as Lugano Stage II. Due to tumor location and the patient's poor general condition, both surgery and chemotherapy were considered infeasible, and best supportive care was chosen. The patient died on hospital Day 33. Jejunocolic fistula caused by MEITL is exceptionally rare. To our knowledge, this is the first reported case in which the fistulous opening was directly visualized endoscopically and a histopathological diagnosis was established by biopsy during life. This case highlights that, in patients with marked weight loss and hypoalbuminemia, gastrointestinal fistula formation should raise suspicion for malignant lymphoma, including MEITL, and that careful endoscopic examination and biopsy may contribute to early diagnosis.
Background
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare form of primary intestinal lymphoma characterized by rapid progression and poor prognosis. Fistula formation due to intestinal lymphoma is uncommon, and this study presents a unique case of MEITL with a jejunocolic fistula. Understanding such rare presentations is crucial for early diagnosis and management.
Methods
This is a case report of an 83-year-old woman diagnosed with MEITL. The patient underwent various diagnostic imaging, including computed tomography and positron emission tomography-computed tomography (PET-CT), along with endoscopic examination and biopsy to confirm the diagnosis.
Results
The primary finding was the visualization of a jejunocolic fistula during endoscopy, which is the first reported case of its kind. The patient was diagnosed with MEITL, and the disease was classified as Lugano Stage II based on PET-CT findings.
Interpretation
This case adds to the limited literature on MEITL and highlights the potential for gastrointestinal fistula formation in such malignancies. However, the findings are based on a single case, limiting the generalizability of the conclusions. The clinical significance of the findings is unclear due to the absence of comparative data.
Key findings
- 20-kg weight loss over the preceding year.
- Hypoalbuminemia and elevated inflammatory markers were reported.
- PET-CT showed abnormal FDG uptake from the jejunum to the transverse colon.
- Disease classified as Lugano Stage II.
- Patient died on hospital Day 33.
Limitations
- Single case report with no statistical analysis.
- No control group or comparative data.
- Limited generalizability of findings.
- Short follow-up duration until patient death.