Cytotoxic T-cell lymphoma diffusely involving the entire gastrointestinal tract associated with Epstein-Barr virus and tubercle bacilli infection.
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.
Abe
Y
Y
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. abey@intmed3.med.kyushu-u.ac.jp
Muta
K
K
Ohshima
K
K
Hirase
N
N
Matsushima
T
T
Yufu
Y
Y
Nishimura
J
J
Nawata
H
H
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