Coeliac Disease Complicating to B Cell Lymphoma and Enterocolic Fistula

Abstract

We describe the case of 66 year old male, known case of COPD and type II diabetes mellitus, with a diagnosis of coeliac disease confirmed by the elevated titers of antigliadin and antiendomysium IgG antibodies together with partial villous atrophy in jejunal histology, complicating to diffuse large B cell lymphoma presented as enterocolic fistula. Laparotomy was performed which included gastrojejun- ostomy to bypass the fistula, ileo-ileal anastomosis to prevent obstruction, and end-transverse colos- tomy. Histology was taken from fistulous tract following laparotomy suspected high-grade non-Hodgkin's lymphoma. Further supplementary reports showed immunoperoxidase studies that the tumor cells are strongly positive for LCA and negative for CD30 and S100. These findings are sug- gestive of high grade non Hodgkins lymphoma which is confirmed by immunohistochemistry results. The biopsy showed high proliferation and soft tissue infiltration by diffuse large B-cell lymphoma which shows extensive apoptosis secondary to a complication of coeliac disease presenting as enterocoloc fistula.

Keywords

• Celiac disease, lymphoma, B-Cell,fistula.