Scientific PapersGastrointestinal malignancies in patients with celiac sprue
Section snippets
Patients and methods
The mainframe of the Department of Pathology at Rhode Island Hospital was searched from its inception in 1986 to April 1997, for all patients with celiac disease whose course was complicated by malignancy. Two patients were identified and their records reviewed. (Figure 1, Figure 2).
The world literature was also reviewed from 1966 to 1997 using Medline. Eight case series and 9 case reports of celiac disease complicated by malignancies were identified. The analysis included demographic data,
Demographics
A total of 82 patients were available for analysis. Half of the patients reviewed were men and half were women. The mean age at the time of diagnosis of malignancy was 56.9 years for men and 52 years for women.
Presenting signs and symptoms
In patients with known celiac disease, malignancy was most commonly characterized by an exacerbation of the malabsorption syndrome, with worsening anorexia, nausea, vomiting, diarrhea, and weight loss. A perforated viscus was often the initial complication leading to a cancer diagnosis,
Comments
Malignant lymphoma occurring in association with celiac disease was first described in 1937,5 and was long thought to be a form of malignant histiocytosis, before the identification of the T-lymphocyte as the malignant cell population.6, 7 The incidence of T-cell lymphoma involving the gastrointestinal tract in patients with celiac sprue ranges from 3.6% over 3 years to 40% over 16 years.8 The malignant cell population appears to arise from the chronic reactive inflammatory infiltrate of the
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