1/7. Heterogeneity of intraepithelial lymphocytes in refractory sprue: potential implications of CD30 expression.BACKGROUND: Refractory sprue is defined as primary or secondary failure to respond to a gluten free diet in patients with coeliac disease-like enteropathy and may signify cryptic or overt enteropathy associated T cell lymphoma. AIMS: To study in detail jejunal morphology and immunophenotypes in patients with refractory sprue in the search for features that might be useful to predict prognosis. patients: Seven patients are described, representing all such cases identified in our hospital over a 13 year period. methods: biopsy and/or surgical resection specimens were examined by morphology, immunohistochemistry, including enzymatic and immunofluorescent detection, and molecular biology. RESULTS: All patients had phenotypically abnormal intraepithelial lymphocytes (IELs) that lacked CD8, T cell receptor alpha beta (or gamma delta), and/or expressed CD30 in addition to variable expression of the natural killer cell receptor CD94. A monoclonal T cell population was present in six cases, data from the seventh being inconclusive. Three patients had overt lymphoma with CD30 tumour tissue intervening between intact mucosa that contained neoplastic IELs. Intriguingly, CD30 IELs were observed both a long way away from, and in direct continuity with, the tumours in these patients. Such CD30 cells were hardly detected in patients without tumours, two of which are in good health several years after the initial diagnosis. CONCLUSIONS: Our data suggest that abnormal IELs in patients with refractory sprue are phenotypically heterogeneous. CD30 expression by these cells may indicate a worse prognosis, including the occurrence of overt lymphoma.- - - - - - - - - - ranking = 1keywords = sprue (Clic here for more details about this article) |
2/7. T-cell intestinal lymphoma associated with celiac sprue.A patient with a long history of celiac sprue developed a pleomorphic intestinal lymphoma. Cell suspensions of tumor cells and immunoperoxidase labeling of cell surface antigens in frozen tissue sections clearly showed the lymphoma to be of T-cell origin, despite the presence of other nontumor cells bearing enzyme markers of histiocytes. These findings may have important implications on the cellular origin of lymphomas developing in patients with celiac sprue.- - - - - - - - - - ranking = 0.85714285714286keywords = sprue (Clic here for more details about this article) |
3/7. Multifocal small bowel lymphoma and latent celiac sprue.Malignant small intestinal lymphoma may complicate or antedate clinical recognition of celiac sprue, a disorder becoming increasingly diagnosed as a subclinical or occult disease. A 73-yr-old woman with previously resected jejunoileal lymphoma and normal proximal small bowel biopsy specimens was given a high-gluten diet containing 40 g of added gluten daily for 4 wk. This caused small intestinal biopsy abnormalities typical of celiac sprue; the abnormalities resolved 6 wk later with a gluten-free diet. This indicates that latent celiac sprue may be present in some patients with lymphoma and suggests that the association of celiac sprue and lymphoma may be more frequent than is currently appreciated.- - - - - - - - - - ranking = 1.1428571428571keywords = sprue (Clic here for more details about this article) |
4/7. Small bowel malignant lymphoma complicating celiac sprue and the mesenteric lymph node cavitation syndrome.Malignant small intestinal lymphoma may complicate or antedate clinical recognition of celiac sprue. However, histologic diagnosis of lymphoma is made especially difficult in the presence of small bowel ulceration. A 70-yr-old man with celiac sprue and a history of dermatitis herpetiformis was initially seen for recurrent diarrhea; panmalabsorption with steatorrhea and protein-losing enteropathy were documented. Subsequent studies showed ectopic gastric mucosa in the small bowel, hyposplenism with mesenteric lymph node cavitation, and small bowel erosions and ulceration. Despite strong clinical suspicion for more than 2 yr, only 1 of 88 small bowel biopsy specimens was positive for lymphoma. At autopsy, shortly after histologic diagnosis of lymphoma, extensive small bowel involvement and infiltration were observed. This is the first report of lymphoma complicating the recently described nonneoplastic lymphoreticular syndrome associated with celiac sprue characterized by splenic atrophy and mesenteric lymph node cavitation.- - - - - - - - - - ranking = 1keywords = sprue (Clic here for more details about this article) |
5/7. Celiac sprue complicated by lymphoma presenting with multiple gastric ulcers.A 40-yr-old woman with celiac sprue, which had responded clinically and histologically to gluten elimination, subsequently developed gastrointestinal lymphoma. Although this has been described in the small intestine of patients with celiac sprue, the unique feature in this patient was her initial presentation with multiple gastric ulcers refractory to conventional medical therapy. This case demonstrates that lymphoma complicating celiac sprue may present with multiple refractory gastric ulcers in addition to those occurring in the small intestine.- - - - - - - - - - ranking = 1keywords = sprue (Clic here for more details about this article) |
6/7. Lymphocytic interstitial pneumonia and abdominal lymphoma complicating celiac sprue.We report the development of lymphocytic interstitial pneumonia followed later by abdominal lymphoma in a 62-year-old woman with celiac sprue. She presented with dyspnea, cough, weight loss, and bibasilar pulmonary infiltrates. lung biopsy demonstrated lymphocytic interstitial pneumonia and corticosteroid therapy resulted in clinical and radiological improvement. She remained well for just over a year until abdominal pain developed and investigation revealed an abdominal lymphoma. Chemotherapy effectively controlled the lymphoma while the lymphocytic interstitial pneumonia was satisfactorily managed by corticosteroid therapy. Although lymphoma is a well-recognized complication of celiac sprue, it is not associated with lymphocytic interstitial pneumonia, despite a number of other reports describing the occurrence of pulmonary disease in this disorder.- - - - - - - - - - ranking = 0.85714285714286keywords = sprue (Clic here for more details about this article) |
7/7. adenocarcinoma of jejunum in association with nontropical sprue.A variety of small-bowel malignant neoplasms have been reported in association with nontropical sprue (celiac disease). Lymphomas have been the most common malignant neoplasms to complicate this disease. However, adenocarcinoma of the small bowel has infrequently been reported. The suggestion has been made that patients with nontropical sprue are at increased risk for developing small-bowel adenocarcinoma. Three additional cases of small-bowel adenocarcinoma in association with nontropical sprue are reported.- - - - - - - - - - ranking = 1keywords = sprue (Clic here for more details about this article) |