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Celiac Disease & Lymphoproliferative Malignancy at Adulthood

Hakim Rahmoune , Nada Boutrid, Mounira Amrane, Soraya Ouhida, Djamel Abdellouche, Belkacem Bioud
International Journal of Celiac Disease. 2018, 6(2), 47-48. DOI: 10.12691/ijcd-6-2-7
Published online: June 15, 2018

Abstract

Celiac disease (CD) is associated with an increased risk for malignancy, specially lymphoproliferative. During a retrospective annual study of intestinal biopsies results in the pathology department at the University Hospital of Setif, we were only half surprised to find a lymphoma in an adult patient initially presenting a CD. We briefly present this case with a review of the current literature.

1. Introduction

Celiac disease (CD) is an auto-immune disease triggered by dietary exposure to gluten in genetically susceptible population (carrying HLA-DQ2 Or HLA-DQ8) 1.

CD in adulthood depicts a higher frequency extra_intestinal manifestations as well as many associations with other immune mediated diseases and malignanciers. Particularly, CD is associated with an increased risk for lymphoproliferative malignancy, while other types of malignancies are sparsely reported 2, 3.

2. Material and Method

We made a retrospective study of the reports of intestinal biopsies in celiac patients in the University Hospital of Setif.

Thus, a group of interns in medicine collected the histological reports of these biopsies at the department of pathology during the year 2016 (from January 1st to December 31st, 2016).

We analyzed various data including the different associated lesions in celiac population.

3. Results

We collected fifty nine (59) reports of both adult and pediatric celiac patients (32 adults and 17 children).

We found one patient (1.7% of the total reports) that associated celiac disease and intestinal (small bowel) lymphoma.

Further information about this case (a female patient, 41 years old) could not been obtained (anonymous data).

4. Discussion

Evidence, including population-based studies, confirmed that patients with diagnosed CD are at increased risk of malignancy and mortality 4, 5.

Notably, patients with CD have an increased risk of lympho-proliferative malignancy and gastrointestinal cancer; and enteropathy-associated T cell lymphoma may occur in a subgroup of patients with refractory CD 6, 7.

Inversely, reduced IgA and IgG levels lead to a lower detection rate of serological screening for CD in patients with a history of lymphoma 8.

A recent meta-analysis found that CD was particularly associated with an overall increased risk of gastro-intestinal malignancies like esophageal cancer and small intestinal carcinoma 9.

Persistent villous atrophy during CD compared with mucosal healing was associated with an increased risk for lymphoproliferative neoplasms 10.

In such cases of complicated CD, enteroscopy (wireless or wired) is considered as an efficient diagnostic tool for the detection of malignant and premalignant lesions of the small bowel 11, 12.

At the opposite, some evidence suggests that a gluten free diet could reduce the risk of lymphoproliferative malignancy, and even reduces the overall risk of mortality 4.

As mentioned before, in addition to digestive neoplasms, CD patients present also a higher risk to develop other malignancies like 13, 14, 15.

5. Conclusion

Celiac disease prevalence is increasing worldwide, and awareness about its complications should also increase.

Malignancies are a well-recognized risk in celiac adults ; and this potential risk is affected by precocious diagnosis and correct management (including the cornerstone gluten free diet).

Counseling and recognizing such at-risk patients would be a valuable, highly effective predictive medicine.

Acknowledgments

We would warmly thank the interns that collected the data for this work, Doctors: Mouaad Boucherit, Kenza Bouchikh, Kamel Boudjerada, Hanane Boulahlib, Manal Boulmerka, Lamri Djehida, Youcef Jabari and Hichem Khelifi.

References

[1]  Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009; 373: 1480-93.
In article      View Article
 
[2]  Spijkerman M, Tan IL, Kolkman JJ, Withoff S, Wijmenga C, Visschedijk MC, Weersma RK. A large variety of clinical features and concomitant disorders in celiac disease–A cohort study in the Netherlands. Digestive and Liver Disease. 2016 May 1; 48(5): 499-505.
In article      View Article  PubMed
 
[3]  Freeman HJ. Celiac disease and selected long-term health issues. Maturitas. 2012 Nov 1; 73(3): 206-11.
In article      View Article  PubMed
 
[4]  Ludvigsson JF. Mortality and malignancy in celiac disease. Gastrointestinal Endoscopy Clinics. 2012 Oct 1; 22(4): 705-22.
In article      View Article  PubMed
 
[5]  Rubio-Tapia A, Ludvigsson JF, Brantner TL, Rajkumar SV, Landgren O, Murray JA. Increased mortality among men aged 50 years old or above with elevated IgA anti-transglutaminase antibodies: NHANES III. BMC gastroenterology. 2016 Dec; 16(1): 136.
In article      View Article  PubMed
 
[6]  Smedby KE, Åkerman M, Hildebrand H, Glimelius B, Ekbom A, Askling J. Malignant lymphomas in coeliac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut. 2005 Jan 1; 54(1): 54-9.
In article      View Article  PubMed
 
[7]  Elfström P, Granath F, Ekström Smedby K, Montgomery SM, Askling J, Ekbom A, Ludvigsson JF. Risk of lymphoproliferative malignancy in relation to small intestinal histopathology among patients with celiac disease. Journal of the National Cancer Institute. 2011 Feb 2; 103(5): 436-44.
In article      View Article  PubMed
 
[8]  Balihar K, Kozeluhova J, Hejda V, Krcma M, Lysak D, Gorcikova J, Hes O, Matejovic M. Diagnosing celiac disease in patients with a history of lymphoma: factors that matter. Wiener klinische Wochenschrift. 2013 Nov 1; 125(21-22): 696-703.
In article      View Article  PubMed
 
[9]  Han Y, Chen W, Li P, Ye J. Association between coeliac disease and risk of any malignancy and gastrointestinal malignancy: a meta-analysis. Medicine. 2015 Sep; 94(38).
In article      View Article
 
[10]  Lebwohl B, Granath F, Ekbom A, Smedby KE, Murray JA, Neugut AI, Green PH, Ludvigsson JF. Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study. Annals of internal medicine. 2013 Aug 6; 159(3): 169-75.
In article      View Article  PubMed
 
[11]  Tomba C, Elli L, Bardella MT, Soncini M, Contiero P, Roncoroni L, Locatelli M, Conte D. Enteroscopy for the early detection of small bowel tumours in at-risk celiac patients. Digestive and Liver Disease. 2014 May 1; 46(5): 400-4.
In article      View Article  PubMed
 
[12]  Elli L, Casazza G, Locatelli M, Branchi F, Ferretti F, Conte D, Fraquelli M. Use of enteroscopy for the detection of malignant and premalignant lesions of the small bowel in complicated celiac disease: a meta-analysis. Gastrointestinal endoscopy. 2017 Aug 1; 86(2): 264-73.
In article      View Article  PubMed
 
[13]  Green PHR, Aaron TF, Bhagat G, et al. Risk of malignancy in patients with celiacdisease. American Journal of Medicine 2003: 115.
In article      View Article
 
[14]  Grainge MJ, West J, Solaymani-Dodaran M, et al. The long-term risk ofmalignancy following a diagnosis of coeliac disease or dermatitis herpeti-formis: a cohort study. Alimentary Pharmacology and Therapeutics 2012; 35: 730–9.
In article      View Article  PubMed
 
[15]  Tio M, Cox MR, Eslick GD. Meta-analysis: coeliac disease and the risk of all-causemortality, any malignancy and lymphoid malignancy. Alimentary Pharmacol-ogy and Therapeutics 2012; 35: 540-51.
In article      View Article  PubMed
 
[16]  Ilus T, Kaukinen K, Virta LJ, et al. Incidence.
In article      
 

Published with license by Science and Education Publishing, Copyright © 2018 Hakim Rahmoune, Nada Boutrid, Mounira Amrane, Soraya Ouhida, Djamel Abdellouche and Belkacem Bioud

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Cite this article:

Normal Style
Hakim Rahmoune, Nada Boutrid, Mounira Amrane, Soraya Ouhida, Djamel Abdellouche, Belkacem Bioud. Celiac Disease & Lymphoproliferative Malignancy at Adulthood. International Journal of Celiac Disease. Vol. 6, No. 2, 2018, pp 47-48. http://pubs.sciepub.com/ijcd/6/2/7
MLA Style
Rahmoune, Hakim, et al. "Celiac Disease & Lymphoproliferative Malignancy at Adulthood." International Journal of Celiac Disease 6.2 (2018): 47-48.
APA Style
Rahmoune, H. , Boutrid, N. , Amrane, M. , Ouhida, S. , Abdellouche, D. , & Bioud, B. (2018). Celiac Disease & Lymphoproliferative Malignancy at Adulthood. International Journal of Celiac Disease, 6(2), 47-48.
Chicago Style
Rahmoune, Hakim, Nada Boutrid, Mounira Amrane, Soraya Ouhida, Djamel Abdellouche, and Belkacem Bioud. "Celiac Disease & Lymphoproliferative Malignancy at Adulthood." International Journal of Celiac Disease 6, no. 2 (2018): 47-48.
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[1]  Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009; 373: 1480-93.
In article      View Article
 
[2]  Spijkerman M, Tan IL, Kolkman JJ, Withoff S, Wijmenga C, Visschedijk MC, Weersma RK. A large variety of clinical features and concomitant disorders in celiac disease–A cohort study in the Netherlands. Digestive and Liver Disease. 2016 May 1; 48(5): 499-505.
In article      View Article  PubMed
 
[3]  Freeman HJ. Celiac disease and selected long-term health issues. Maturitas. 2012 Nov 1; 73(3): 206-11.
In article      View Article  PubMed
 
[4]  Ludvigsson JF. Mortality and malignancy in celiac disease. Gastrointestinal Endoscopy Clinics. 2012 Oct 1; 22(4): 705-22.
In article      View Article  PubMed
 
[5]  Rubio-Tapia A, Ludvigsson JF, Brantner TL, Rajkumar SV, Landgren O, Murray JA. Increased mortality among men aged 50 years old or above with elevated IgA anti-transglutaminase antibodies: NHANES III. BMC gastroenterology. 2016 Dec; 16(1): 136.
In article      View Article  PubMed
 
[6]  Smedby KE, Åkerman M, Hildebrand H, Glimelius B, Ekbom A, Askling J. Malignant lymphomas in coeliac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut. 2005 Jan 1; 54(1): 54-9.
In article      View Article  PubMed
 
[7]  Elfström P, Granath F, Ekström Smedby K, Montgomery SM, Askling J, Ekbom A, Ludvigsson JF. Risk of lymphoproliferative malignancy in relation to small intestinal histopathology among patients with celiac disease. Journal of the National Cancer Institute. 2011 Feb 2; 103(5): 436-44.
In article      View Article  PubMed
 
[8]  Balihar K, Kozeluhova J, Hejda V, Krcma M, Lysak D, Gorcikova J, Hes O, Matejovic M. Diagnosing celiac disease in patients with a history of lymphoma: factors that matter. Wiener klinische Wochenschrift. 2013 Nov 1; 125(21-22): 696-703.
In article      View Article  PubMed
 
[9]  Han Y, Chen W, Li P, Ye J. Association between coeliac disease and risk of any malignancy and gastrointestinal malignancy: a meta-analysis. Medicine. 2015 Sep; 94(38).
In article      View Article
 
[10]  Lebwohl B, Granath F, Ekbom A, Smedby KE, Murray JA, Neugut AI, Green PH, Ludvigsson JF. Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study. Annals of internal medicine. 2013 Aug 6; 159(3): 169-75.
In article      View Article  PubMed
 
[11]  Tomba C, Elli L, Bardella MT, Soncini M, Contiero P, Roncoroni L, Locatelli M, Conte D. Enteroscopy for the early detection of small bowel tumours in at-risk celiac patients. Digestive and Liver Disease. 2014 May 1; 46(5): 400-4.
In article      View Article  PubMed
 
[12]  Elli L, Casazza G, Locatelli M, Branchi F, Ferretti F, Conte D, Fraquelli M. Use of enteroscopy for the detection of malignant and premalignant lesions of the small bowel in complicated celiac disease: a meta-analysis. Gastrointestinal endoscopy. 2017 Aug 1; 86(2): 264-73.
In article      View Article  PubMed
 
[13]  Green PHR, Aaron TF, Bhagat G, et al. Risk of malignancy in patients with celiacdisease. American Journal of Medicine 2003: 115.
In article      View Article
 
[14]  Grainge MJ, West J, Solaymani-Dodaran M, et al. The long-term risk ofmalignancy following a diagnosis of coeliac disease or dermatitis herpeti-formis: a cohort study. Alimentary Pharmacology and Therapeutics 2012; 35: 730–9.
In article      View Article  PubMed
 
[15]  Tio M, Cox MR, Eslick GD. Meta-analysis: coeliac disease and the risk of all-causemortality, any malignancy and lymphoid malignancy. Alimentary Pharmacol-ogy and Therapeutics 2012; 35: 540-51.
In article      View Article  PubMed
 
[16]  Ilus T, Kaukinen K, Virta LJ, et al. Incidence.
In article