suspicion of t cell lymphoma complication of coeliac disease
| Discussion in 'All Categories' started by raj - Jul 24th, 2012 1:47 pm. | |
raj
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check up full area from stomach to colon and lymph nodes and resection or full thickness biopsy of the small intestine disease mostly in jejunum and ileum. |
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re: suspicion of t cell lymphoma complication of coeliac disease
by Dr M K Gupta -
Jul 29th, 2012
3:40 am
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Dr M K Gupta
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Dear Raj, One severe complication of coeliac disease is enteropathy-associated T cell lymphoma, a high-grade invasive lymphoma with a inadequate prognosis. Previous studies have suggested that chronic exposure of immune cells in the walls from the small intestine, which are known as intraepithelial lymphocytes, to potent anti-death signals initiated by the soluble factor IL-15 plays a role in the development of enteropathy-associated T cell lymphoma. Molecular biological and immunohistochemical research indicates the intestinal mucosa distant from the tumour contains clonal populations of small T cells, often of the same clone as the high-grade T-cell lymphoma. These findings suggest that enteropathy-associated T-cell lymphoma arises in the setting of coeliac disease and evolves from reactive intraepithelial lymphocytes through a low-grade lymphocytic neoplasm to a high-grade tumour, which is usually cause of the presenting symptoms. Most cases of chronic ulcerative enteropathy (ulcerative jejunitis) are most likely part of the same disease process. When the ulceration occurs at any given time once the neoplastic T-cells are of a poor quality, morphological recognition of tumour cells within the ulcers may be impossible. Adherence to a strict GFD is fully necessary in lessening the chance of developing CD complications, and its protective effect was shown a lot more than Two decades ago; previously few years, many papers have addressed this issue, confirming its importance The suspicion of EATL should lead to an extensive diagnostic workup in which MR enteroclysis, coupled with PET scan and histologic identification of lesions, represents the best options. The best current treatment choice is high-dose chemotherapy, preceded by surgical resection and then ASCT, although this process could simply be put on a strictly selected quantity of patients able to tolerate it. Further research is required to verify whether innovative therapies might be of help in treating or preventing EATL. Strict adherence to some GFD remains the best option to avoid EATL in patients with CD. So in our opinion you need thorough diagnosis first and according to that corrective measure has to be taken. With regards M K Gupta With regards M.K.Gupta |