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Plasmablastic lymphoma in the ano-rectal junction presenting in an immunocompetent man: a case report.

Brahmania M, Sylwesterowic T, Leitch H - J Med Case Rep (2011)

Bottom Line: A previously healthy 59-year-old Caucasian man presented with painless rectal bleeding.Immunohistochemical analysis showed the atypical cells were negative for CD45, CD20, CD79a and immunoglobulin light chains, but were strongly positive for CD138 and EBV-encoded RNA.Aggressive systemic chemotherapy and involved field radiation therapy resulted in complete clinical and pathological remission.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Division of Gastroenterology & Hematology, St Paul's Hospital, Vancouver, BC, V5Z 1M9, Canada. mab977@mail.usask.ca.

ABSTRACT

Introduction: Plasmablastic lymphoma is an aggressive non-Hodgkin lymphoma classically occurring in individuals infected with HIV. Plasmablastic lymphoma has a predilection for the oral cavity and jaw. However, recent case reports have shown lymphoma in the stomach, lung, nasal cavity, cervical lymph nodes and jejunum in HIV-negative individuals. We report what is, to the best of our knowledge, the first case of plasmablastic lymphoma occurring in the ano-rectal junction of an HIV-negative man.

Case presentation: A previously healthy 59-year-old Caucasian man presented with painless rectal bleeding. Colonoscopy revealed a lesion in the ano-rectal junction, with pathological examination demonstrating atypical lymphoid cells consisting primarily of plasmablasts with rounded nuclei, coarse chromatin, small nucleoli and multiple mitotic figures. Immunohistochemical analysis showed the atypical cells were negative for CD45, CD20, CD79a and immunoglobulin light chains, but were strongly positive for CD138 and EBV-encoded RNA. The results were consistent with a diagnosis of plasmablastic lymphoma. Aggressive systemic chemotherapy and involved field radiation therapy resulted in complete clinical and pathological remission.

Conclusion: Increasing awareness of plasmablastic lymphoma in HIV-negative individuals and in this location is warranted.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemical staining (a) CD45 (b) CD20 (c) CD138 (d) EBER.
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Figure 2: Immunohistochemical staining (a) CD45 (b) CD20 (c) CD138 (d) EBER.

Mentions: Our patient underwent a colonoscopy which showed a normal colon apart from a 5 mm polyp at 20 cm which was hyperplastic by pathologic examination. At the ano-rectal junction, a hypervascular cauliflower-like mass of 3 mm was seen and biopsied (Figure 1). Histopathological examination demonstrated abundant atypical large lymphoid cells with lesser numbers of plasma cells. The atypical lymphoid cell population consisted predominantly of plasmablasts with rounded nuclei, coarse chromatin, small nucleoli and multiple mitotic figures. Immunohistochemical analysis showed the atypical cells were negative for CD3, CD5, CD10, CD20, CD30, CD45, CD56, BCL-2, BCL-6, CD45 (Figure 2a), CD20 (Figure 2b), CD79a. Furthermore, we could not detect any restriction of immunoglobulin light chains (kappa or lambda), or expression of immunoglobulin heavy chains IgG, IgM, IgD; however there was cytoplasmic expression of IgA. In contrast, the neoplastic cells were strongly positive for MUM1, epithelial membrane antigen, CD38, CD138 (Figure 2c) and EBV-encoded RNA (EBER) (Figure 2d). There was no expression of LANA-1. The proliferation index by Ki-67 immunohistochemistry was approximately 70%. The results were consistent with a diagnosis of PBL.


Plasmablastic lymphoma in the ano-rectal junction presenting in an immunocompetent man: a case report.

Brahmania M, Sylwesterowic T, Leitch H - J Med Case Rep (2011)

Immunohistochemical staining (a) CD45 (b) CD20 (c) CD138 (d) EBER.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3107799&req=5

Figure 2: Immunohistochemical staining (a) CD45 (b) CD20 (c) CD138 (d) EBER.
Mentions: Our patient underwent a colonoscopy which showed a normal colon apart from a 5 mm polyp at 20 cm which was hyperplastic by pathologic examination. At the ano-rectal junction, a hypervascular cauliflower-like mass of 3 mm was seen and biopsied (Figure 1). Histopathological examination demonstrated abundant atypical large lymphoid cells with lesser numbers of plasma cells. The atypical lymphoid cell population consisted predominantly of plasmablasts with rounded nuclei, coarse chromatin, small nucleoli and multiple mitotic figures. Immunohistochemical analysis showed the atypical cells were negative for CD3, CD5, CD10, CD20, CD30, CD45, CD56, BCL-2, BCL-6, CD45 (Figure 2a), CD20 (Figure 2b), CD79a. Furthermore, we could not detect any restriction of immunoglobulin light chains (kappa or lambda), or expression of immunoglobulin heavy chains IgG, IgM, IgD; however there was cytoplasmic expression of IgA. In contrast, the neoplastic cells were strongly positive for MUM1, epithelial membrane antigen, CD38, CD138 (Figure 2c) and EBV-encoded RNA (EBER) (Figure 2d). There was no expression of LANA-1. The proliferation index by Ki-67 immunohistochemistry was approximately 70%. The results were consistent with a diagnosis of PBL.

Bottom Line: A previously healthy 59-year-old Caucasian man presented with painless rectal bleeding.Immunohistochemical analysis showed the atypical cells were negative for CD45, CD20, CD79a and immunoglobulin light chains, but were strongly positive for CD138 and EBV-encoded RNA.Aggressive systemic chemotherapy and involved field radiation therapy resulted in complete clinical and pathological remission.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Division of Gastroenterology & Hematology, St Paul's Hospital, Vancouver, BC, V5Z 1M9, Canada. mab977@mail.usask.ca.

ABSTRACT

Introduction: Plasmablastic lymphoma is an aggressive non-Hodgkin lymphoma classically occurring in individuals infected with HIV. Plasmablastic lymphoma has a predilection for the oral cavity and jaw. However, recent case reports have shown lymphoma in the stomach, lung, nasal cavity, cervical lymph nodes and jejunum in HIV-negative individuals. We report what is, to the best of our knowledge, the first case of plasmablastic lymphoma occurring in the ano-rectal junction of an HIV-negative man.

Case presentation: A previously healthy 59-year-old Caucasian man presented with painless rectal bleeding. Colonoscopy revealed a lesion in the ano-rectal junction, with pathological examination demonstrating atypical lymphoid cells consisting primarily of plasmablasts with rounded nuclei, coarse chromatin, small nucleoli and multiple mitotic figures. Immunohistochemical analysis showed the atypical cells were negative for CD45, CD20, CD79a and immunoglobulin light chains, but were strongly positive for CD138 and EBV-encoded RNA. The results were consistent with a diagnosis of plasmablastic lymphoma. Aggressive systemic chemotherapy and involved field radiation therapy resulted in complete clinical and pathological remission.

Conclusion: Increasing awareness of plasmablastic lymphoma in HIV-negative individuals and in this location is warranted.

No MeSH data available.


Related in: MedlinePlus