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A Case Report of NK-Cell Lymphoproliferative Disease With a Wide Involvement of Digestive Tract Develop Into Epstein – Barr Virus Associated NK/T Cell Lymphoma in an Immunocompetent Patient

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ABSTRACT

Epstein–Barr virus (EBV) plays an important role in various diseases. EBV-associated lymphoproliferative disease (LPD) is a rare disease with a canceration tendency. It is difficult to differentiate LPD with involvement of digestive tract from Crohn disease due to similar clinical and endoscopic manifestations. We present a case report of multiple ulcers with esophagus, small bowel and the entire colon involved, proved to be NK-Cell LPD, developed into EBV-associated NK/T Cell lymphoma, in an immunocompetent man who was initially misdiagnosed as Crohn disease.

This report underscores that intestinal ulcers should be cautiously diagnosed, for it sometimes could be a precancerous lesion.

No MeSH data available.


Related in: MedlinePlus

Histologic findings of the lymphoma tissue under the microscope. (A) The cells are large with irregularly shaped or angulated nuclei and a variable amount of cytoplasm (HE stain, 400×). (B) The cells in this case diffusely express CD56 (magnification, 400×). (C) The cells express Ki67 (magnification, 400×). (D) The cells express EBER (magnification, 400×).
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Figure 3: Histologic findings of the lymphoma tissue under the microscope. (A) The cells are large with irregularly shaped or angulated nuclei and a variable amount of cytoplasm (HE stain, 400×). (B) The cells in this case diffusely express CD56 (magnification, 400×). (C) The cells express Ki67 (magnification, 400×). (D) The cells express EBER (magnification, 400×).

Mentions: After 2 weeks of hospitalization, he developed a fierce abdominal pain. The X-ray prompted an intestinal perforation. An emergency surgery was performed. During the surgery, it was found that there was a 5-cm break in the small bowel 35 cm from the ileocecal valve, the intestinal wall around the break was edematous, and mesenterium was thickened with multiple enlarged lymph nodes. He underwent partial intestinal bowel resection and terminal ileum colostomy. Histological examination of surgical samples revealed lymphoma cells. Immunohistochemical staining (IHC) showed that these cells were diffusely positive for CD56 and EBV-encoded small RNA (EBER) expressions, with a high Ki67 expression rate (Figure 3). He was diagnosed as extranodal NK/T cell lymphoma (nasal type). Then we reviewed the histological slides of the esophagus, small bowel, and the colon biopsies, and we examined the CD56, EBER, and Ki67 expression rates in these samples by IHC. A positive CD56 expression, a positive EBER expression and a 10%-positive Ki67 expression were found in all the esophagus, small bowel, and the colon samples (Figure 4). EBV-associated LPD was made as a pathological diagnosis.


A Case Report of NK-Cell Lymphoproliferative Disease With a Wide Involvement of Digestive Tract Develop Into Epstein – Barr Virus Associated NK/T Cell Lymphoma in an Immunocompetent Patient
Histologic findings of the lymphoma tissue under the microscope. (A) The cells are large with irregularly shaped or angulated nuclei and a variable amount of cytoplasm (HE stain, 400×). (B) The cells in this case diffusely express CD56 (magnification, 400×). (C) The cells express Ki67 (magnification, 400×). (D) The cells express EBER (magnification, 400×).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998401&req=5

Figure 3: Histologic findings of the lymphoma tissue under the microscope. (A) The cells are large with irregularly shaped or angulated nuclei and a variable amount of cytoplasm (HE stain, 400×). (B) The cells in this case diffusely express CD56 (magnification, 400×). (C) The cells express Ki67 (magnification, 400×). (D) The cells express EBER (magnification, 400×).
Mentions: After 2 weeks of hospitalization, he developed a fierce abdominal pain. The X-ray prompted an intestinal perforation. An emergency surgery was performed. During the surgery, it was found that there was a 5-cm break in the small bowel 35 cm from the ileocecal valve, the intestinal wall around the break was edematous, and mesenterium was thickened with multiple enlarged lymph nodes. He underwent partial intestinal bowel resection and terminal ileum colostomy. Histological examination of surgical samples revealed lymphoma cells. Immunohistochemical staining (IHC) showed that these cells were diffusely positive for CD56 and EBV-encoded small RNA (EBER) expressions, with a high Ki67 expression rate (Figure 3). He was diagnosed as extranodal NK/T cell lymphoma (nasal type). Then we reviewed the histological slides of the esophagus, small bowel, and the colon biopsies, and we examined the CD56, EBER, and Ki67 expression rates in these samples by IHC. A positive CD56 expression, a positive EBER expression and a 10%-positive Ki67 expression were found in all the esophagus, small bowel, and the colon samples (Figure 4). EBV-associated LPD was made as a pathological diagnosis.

View Article: PubMed Central - PubMed

ABSTRACT

Epstein–Barr virus (EBV) plays an important role in various diseases. EBV-associated lymphoproliferative disease (LPD) is a rare disease with a canceration tendency. It is difficult to differentiate LPD with involvement of digestive tract from Crohn disease due to similar clinical and endoscopic manifestations. We present a case report of multiple ulcers with esophagus, small bowel and the entire colon involved, proved to be NK-Cell LPD, developed into EBV-associated NK/T Cell lymphoma, in an immunocompetent man who was initially misdiagnosed as Crohn disease.

This report underscores that intestinal ulcers should be cautiously diagnosed, for it sometimes could be a precancerous lesion.

No MeSH data available.


Related in: MedlinePlus