Clinical Information: 69 year old with 6 month history of watery diarrhea and recent diagnosis of Celiac disease. He presented with an acute abdomen secondary to small bowel perforation. Bowel resection performed.
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Discussion and answer
Diagnosis: Enteropathy Associated T-Cell Lymphoma (EATCL), pleomorphic type
Sections show a flat villous architecture with diffuse crypt hyperplasia, moderate increase in inflammatory cells within the lamina propria and several erosions/ulcers throughout. The inflammatory infiltrate is confined within the surface mucosa except for areas of ulceration, where mixed inflammation is seen in deeper layers of the small bowel wall.
There is marked intraepithelial lymphocytosis. Examination of the site of perforation shows a small number of large atypical cells buried in a reactive inflammatory infiltrate. There are a few abnormal mitotic figures. These large cells are positive for CD3, CD7, CD30 and focally positive for CD8. They are negative for CD4, CD5, CD56 and CD20. These findings are consistent with an enteropathy associated T cell lymphoma, pleomorphic type.