Novel variant of EATL evolving from mucosal γδ-T-cells in a patient with type I RCD

ObjectivesEnteropathy associated T-cell lymphoma (EATL) is a rare non-Hodgkin lymphoma that may complicate coeliac disease and typically occurs in patients with refractoriness to the gluten-free diet. The majority of these patients harbour a clonal expansion of intraepithelial lymphocytes (IELs) wit...

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Published in:BMJ open gastroenterology 2015, Vol.2 (1), p.e000026-e000026
Main Authors: van Wanrooij, R L J, de Jong, D, Langerak, A W, Ylstra, B, van Essen, H F, Heideman, D A M, Bontkes, H J, Mulder, C J J, Bouma, G
Format: Article
Language:English
Subjects:
Abdomen
Celiac disease
Coeliac Disease
Gastroenterology
Immunoglobulins
Lymphatic system
Lymphocytes
Lymphoma
Patients
Physiology
Population
Studies
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Summary:ObjectivesEnteropathy associated T-cell lymphoma (EATL) is a rare non-Hodgkin lymphoma that may complicate coeliac disease and typically occurs in patients with refractoriness to the gluten-free diet. The majority of these patients harbour a clonal expansion of intraepithelial lymphocytes (IELs) with an aberrant phenotype in the small intestine which are thus considered as the ‘precursor’ lymphoma cells. We describe a 51-year-old female patient with refractory coeliac disease (RCD) who developed an EATL with manifestations in the proximal small intestine and in a mesenteric lymph node that did not evolve from regular type ‘aberrant’ αβ-T-cells but rather from a clonal expansion of γδ-T-cells.MethodsDuodenal biopsies and lymphoma tissue from a patient with refractory coeliac disease whom developed an EATL were extensively studied by immunophenotypical, T-cell receptor immunogenetic and chromosomal analysis.ResultsFlow cytometric analysis of duodenal IELs revealed an unusual large clonal expansion of CD30 negative γδ-T-cells in a patient with RCD. When the patient clinically deteriorated 18 months later, a substantial part (30%) of this cell population did express CD30. In addition, identical immunogenetic aberrancies had developed in a prehepatic lymph node.ConclusionsWe here report on a case of extraintestinal EATL that originated from a clonal γδ-IEL population rather than from aberrant IEL. This EATL displayed a distinctive pattern of immunophenotypical, T-cell receptor immunogenetic and chromosomal aberrancies as compared to classical EATL, defining this lymphoma as a novel variant of EATL.
ISSN:2054-4774
2054-4774
DOI:10.1136/bmjgast-2014-000026