ENTEROPATHY ASSOCIATED T-CELL LYMPHOMA – A RARE CAUSE OF ACUTE ABDOMEN
Enteropathy associated T-cell lymphoma (EATL) is an extremely aggressive form of non- Hodgkin lymphoma. EATL is a rare form of peripheral lymphoma with a very poor prognosis and the five-year survival rate reported is between 11 and 20%. We present the case of a 33- years old male admitted for right iliac fossa pain and nausea. Blood test showed leukocytosis with neutrophilia. The conventional X-ray examination of the abdominal region showed a few “air-fluid” levels in the right flank and mesogastric area and the ultrasound found no particular alterations of the abdominal organs. These lead us to suspect an acute appendicitis and the patient was scheduled for emergency surgery. Intraoperative, we ascertain a perforated, stenotic jejunal tumor located at approximately 1 meter from the Treitz angle. A segmental enterectomy was performed with entero-enteral anastomosis end to end. The histopathological and immunohistochemistry examinations established the diagnosis of entheropathy associated T-cell lymphoma. The patient was discharged after a few days and started the proper adjuvant therapy. In most of the cases, the precise diagnosis is not facile, the patient usually presenting with intestinal haemorrhage, intestinal occlusion or perforation, the clinical presentation often misleading the medical team. EATL is usually a diagnosis of exclusion, other differential diagnoses being acute appendicitis, mechanical obstruction, intestinal bacterial infection and others.
 J. M. W. van de Water, S. A. G. M. Cillessen, O. J. Visser, W. H. M. Verbeek, C. J. L. M. Meijer, and C. J. J. Mulder, “Enteropathy associated T-cell lymphoma and its precursor lesions,” Best Pract. Res. Clin. Gastroenterol., vol. 24, no. 1, pp. 43–56, 2010, doi: https://doi.org/10.1016/j.bpg.2009.11.002.
 Z. H. Sun, H. M. Zhou, G. X. Song, Z. X. Zhou, and L. Bai, “Intestinal T-cell lymphomas: A retrospective analysis of 68 cases in China,” World J. Gastroenterol., vol. 20, no. 1, pp. 296–302, 2014, doi: 10.3748/wjg.v20.i1.296.
 D. P. Arps and L. B. Smith, “Classic versus type II enteropathy-associated T-cell lymphoma: diagnostic considerations.,” Arch. Pathol. Lab. Med., vol. 137, no. 9, pp. 1227–1231, 2013, doi: 10.5858/arpa.2013-0242-CR.
 A. Di Sabatino, F. Biagi, P. G. Gobbi, and G. R. Corazza, “How I treat How I treat enteropathy-associated T-cell lymphoma,” vol. 119, no. 11, pp. 2458–2468, 2012, doi: 10.1182/blood-2011-10-385559.2458.
 J. W. Campo, E., Harris, N. L., Jaffe, E. S., Pileri, S. A., Stein, H., Thiele, J., & Vardiman, “WHO classification of tumours of haematopoietic and lymphoid tissues,” 2008, [Online]. Available: http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=70&codcch=4002.
 J. Delabie et al., “Enteropathy-associated T-cell lymphoma: Clinical and histological findings from the international peripheral T-Cell lymphoma project,” Blood, vol. 118, no. 1, pp. 148–155, 2011, doi: 10.1182/blood-2011-02-335216.
 W. H. M. Verbeek, J. M. W. Van De Water, A. Al-Toma, J. J. Oudejans, C. J. J. Mulder, and V. M. H. Coupé, “Incidence of enteropathy--associated T-cell lymphoma: a nation-wide study of a population-based registry in The Netherlands.,” Scand. J. Gastroenterol., vol. 43, no. 11, pp. 1322–1328, 2008, doi: 10.1080/00365520802240222.
 R. Z. Sharaiha, B. Lebwohl, L. Reimers, G. Bhagat, P. H. Green, and A. I. Neugut, “Increasing incidence of enteropathy-associated T-cell lymphoma in the United States, 1973-2008,” Cancer, vol. 118, no. 15, pp. 3786–3792, 2012, doi: 10.1002/cncr.26700.
 I. N. Farstad et al., “Heterogeneity of intraepithelial lymphocytes in refractory sprue: Potential implications of CD30 expression,” Gut, vol. 51, no. 3, pp. 372–378, 2002, doi: 10.1136/gut.51.3.372.
 J. C. Zhang, Y. Wang, X. F. Wang, and F. X. Zhang, “Type I enteropathy-associated T-cell lymphoma in the colon of a 29-year-old patient and a brief literature review,” Onco. Targets. Ther., vol. 9, pp. 863–868, 2016, doi: 10.2147/OTT.S96745.
 J. Gale, P. D. Simmonds, G. M. Mead, J. W. Sweetenham, and D. H. Wright, “Enteropathy-type intestinal T-cell lymphoma: clinical features and treatment of 31 patients in a single center.,” J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol., vol. 18, no. 4, pp. 795–803, Feb. 2000, doi: 10.1200/JCO.2000.18.4.795.
 M. Sieniawski et al., “Evaluation of enteropathy-associated T-cell lymphoma comparing standard therapies with a novel regimen including autologous stem cell transplantation,” Blood, vol. 115, no. 18, pp. 3664–3670, 2010, doi: https://doi.org/10.1182/blood-2009-07-231324.
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