title: Cytotoxic T-cell lymphoma diffusely involving the entire gastrointestinal tract associated with Epstein-Barr virus and tubercle bacilli infection.
abstract: We describe a rare case of cytotoxic gastrointestinal T-cell lymphoma with protein-losing enteropathy. Initial examination revealed the coexistence of T-cell lymphoma and tuberculosis in the mesenteric lymph node and liver. Despite anti-tuberculosis and anti-cancer treatment, the patient experienced chronic diarrhea and malabsorption and died approximately 3 years after onset. Autopsy specimens revealed medium-sized lymphoma cells, with a phenotype of CD3+, CD4-, CD7+, CD8+, CD30-, CD56-, CD103 (HML-1)-, TIA-1+, and granzyme B+, proliferating primarily and consistently in the mucosa of the entire bowel tract from esophagus to rectum. Interestingly, Epstein-Barr virus (EBV)-encoded small nuclear RNAs were detected in the tumors by in situ hybridization. Southern blot analysis revealed monoclonal proliferation in the EBV-infected T cells. Although the present case can possibly be categorized as an intestinal T-cell lymphoma according to the Revised European-American Lymphoma Classification, the case showed a unique clinical course and distribution of lymphoma cells. We present here an interesting case of gastrointestinal cytotoxic T-cell lymphoma and examine the possible association with infectious agents.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. abey@intmed3.med.kyushu-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Abe
authors.forename: K
authors.initials: K
authors.lastname: Muta
authors.forename: K
authors.initials: K
authors.lastname: Ohshima
authors.forename: N
authors.initials: N
authors.lastname: Hirase
authors.forename: T
authors.initials: T
authors.lastname: Matsushima
authors.forename: Y
authors.initials: Y
authors.lastname: Yufu
authors.forename: J
authors.initials: J
authors.lastname: Nishimura
authors.forename: H
authors.initials: H
authors.lastname: Nawata
mesh_terms: D004064:Digestive System / Q000382:microbiology* / Q000473:pathology / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D017254:Leukemic Infiltration / Q000382:microbiology / Q000628:therapy; D016399:Lymphoma, T-Cell / Q000382:microbiology* / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000473:pathology; D009170:Nontuberculous Mycobacteria; D010641:Phenotype; D013602:T-Lymphocytes, Cytotoxic / Q000382:microbiology* / Q000473:pathology / Q000821:virology