# Small bowel lymphoma presenting with frequent perforation: a single center experience focusing on the monomorphic epitheliotropic intestinal T-cell lymphoma

## TL;DR

This study examines monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), a rare small bowel lymphoma with frequent perforation and poor survival, focusing on its clinical features and treatment outcomes.

## Contribution

The study highlights MEITL's distinct clinical features and outcomes in a single-center cohort, emphasizing its association with bowel perforation and poor prognosis.

## Key findings

- MEITL patients had a significantly higher incidence of small bowel perforation (46%) compared to non-MEITL lymphoma patients (8%).
- Median survival for MEITL patients was 8.0 months, with factors like perforation and chemotherapy affecting outcomes.
- MEITL was associated with weight loss, chronic diarrhea, elevated white blood cell counts, and low albumin levels.

## Abstract

Small bowel malignancies are rare and initial symptoms are generally vague and non-specific. Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a primary lymphoma of the gastrointestinal tract typically localizing to the small bowel. We attempted to analyze small bowel lymphoma patients in a tertiary care center focusing on the current diagnostic and treatment strategies of MEITL.

We reviewed patients with histopathology diagnosis of small bowel lymphoma from January 1998 to December 2018. Survival analysis was performed using the Kaplan–Meier method.

There were 140 lymphoma patients with small bowel involvement including 13 MEITL patients (9%). The incidence of small bowel perforation was much higher in MEITL patients than the non-MEITL small bowel lymphoma patients (46% versus 8%, p < .001). MEITL was significantly associated with weight loss, chronic diarrhea, elevated white blood cell counts, and low albumin levels. Most MEITL patients had jejunal involvement with diffuse bowel wall thickening and luminal narrowing in imaging studies. Enteroscopic findings in MEITL were typically characterized by edematous mucosal thickening and multifocal shallow ulcerations, frequently observed alongside a mosaic mucosal pattern or diffuse erosions. Most MEITL patients had received chemotherapy, and two patients received chemotherapy along with autologous stem cell transplantation. The median survival of MEITL was 8.0 months, and was significantly associated with age, performance, perforation status, and anthracycline chemotherapy.

As a rare lymphoma with poor prognosis, MEITL should be considered in Asian patients with jejunal lesions presenting with weight loss, chronic diarrhea, bowel perforation, and characteristic imaging/endoscopic features. Intensive chemotherapy followed by autologous stem cell transplantation may provide a better outcome.