73 Gastric Peripheral T-cell Lymphoma in Untreated Celiac Disease: A Rare and Aggressive Manifestation

Introduction/Objective Celiac disease (CD) is an autoimmune enteropathy triggered by gluten and associated with an elevated risk of lymphoproliferative disorders, especially enteropathy-associated T-cell lymphoma (EATL). Gastric involvement by peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is rare and highly aggressive. Methods/Case Report A 56-year-old woman with a 10-year history of untreated CD presented with progressive epigastric pain, weight loss, anemia, and early satiety. Endoscopic evaluation revealed a 3 cm ulcerated gastric mass. Biopsies were submitted for histopathologic and immunohistochemical analysis. Results Histology demonstrated dense infiltration by atypical lymphoid cells with irregular nuclear contours and increased mitotic activity. Immunohistochemistry showed positivity for CD3 and CD5, and negativity for CD20, CD30, and PanCK. A high Ki-67 proliferation index (∼70%) supported the diagnosis of PTCL-NOS. The patient underwent six cycles of CHOP chemotherapy, but a post-treatment PET scan revealed persistent disease. She succumbed to lymphoma-related complications within one year of diagnosis. Conclusion Conclusions: This case highlights the rare and aggressive presentation of gastric PTCL-NOS in the setting of untreated CD. Early histopathologic diagnosis is essential in patients with refractory upper GI symptoms and CD. Despite chemotherapy, prognosis remains poor, emphasizing the need for early CD recognition and management.