S6115 Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma Diagnosed With Double-Balloon Enteroscopy

Introduction: Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare and aggressive primary intestinal lymphoma, formerly classified as enteropathy associated T-cell lymphoma (EATL) type II. Reclassified by the World Health Organization in 2017, MEITL lacks the celiac disease association seen in EATL type I and is far less common. Due to the aggressive nature of this disease, diagnosis is most often made via surgical intervention in an emergent fashion due to intestinal perforation or obstruction. In 1 of the largest cohort studies of MEITL to date, 30 of 35 patients were diagnosed surgically and only 5 identified endoscopically. We present a case of a patient with subacute onset abdominal symptoms diagnosed with MEITL via double-balloon enteroscopy (DBE). Case Description/Methods: A 54-year-old Hispanic woman with a history of iron deficiency anemia (IDA) refractory to intravenous iron supplementation presented with subacute onset of progressive abdominal pain, early satiety, and 20-pound weight loss. She had an esophagogastroduodenoscopy and colonoscopy 3 years prior to presentation for the IDA which were both overall normal. Celiac serologies were also negative. Upon presentation computed tomography scan demonstrated thickened jejunal loops and borderline mesenteric lymphadenopathy. Given jejunal pathology on imaging, decision made to pursue DBE which reveal severe mucosal changes in distal duodenum and jejunum. Histology from biopsies demonstrated dense monomorphic lymphoid cell infiltration and CD3, CD2, CD7, CD8, and CD56 positivity on IHC consistent with MEITL. Discussion: MEITL is a rare but severe form of intestinal lymphoma most diagnosed in Asian and Hispanic patients. There is limited literature which describes endoscopic diagnosis of MEITL, and to a lesser extent the use of DBE for diagnosis. The median onset of survival is just 7 months; however, early diagnosis can lead to significant improvement in mortality. Our case is a rare presentation which demonstrated early endoscopic evaluation using DBE with prompt diagnosis and initiation of therapy. Our patient has remained without need for operative intervention and on positron emission tomography imaging has demonstrated partial response to her chemotherapy regimen.