A 40-year-old woman presents with chronic watery diarrhoea (8–10 stools/day), weight loss 12 kg over 6 months, and steatorrhoea. Duodenal biopsy shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Anti-tTG IgA is strongly positive. She is started on a gluten-free diet. Which is the MOST common extra-intestinal malignancy associated with her underlying diagnosis?
- A Enteropathy-associated T-cell lymphoma (EATL) of the small intestine ✓
- B Adenocarcinoma of the duodenum
- C Hepatocellular carcinoma due to steatohepatitis
- D Colorectal carcinoma due to mucosal inflammation
Correct answer: A. Enteropathy-associated T-cell lymphoma (EATL) of the small intestine
Explanation
Coeliac disease (gluten-sensitive enteropathy) is associated with significantly increased risk of enteropathy-associated T-cell lymphoma (EATL), arising from aberrant intraepithelial T-lymphocytes. EATL is a rare but highly aggressive complication; risk is reduced by strict long-term adherence to a gluten-free diet. Small bowel adenocarcinoma risk is also increased but less common than EATL in this context. Hepatocellular carcinoma is a complication of liver cirrhosis, not coeliac disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.