title: Primary Esophageal Extranasal NK/T Cell Lymphoma With Biphasic Morphology: A Case Report and Literature Review.
abstract: We report a case of esophageal extranasal NK/T cell lymphoma with biphasic morphologic features revealed by a deep large piecemeal biopsy. A 40-year-old man present with pharyngalgia, dysphagia, recurrent fever, and 5-kg weight loss for 8 months. Endoscopy demonstrated progressing longitudinal ulcers and mucosal bridges along the esophagus. The first and second biopsies obtained superficial mucosa with scattered bland-looking small lymphocytes. A subsequent large piecemeal snare abscission for biopsy showed atypical lymphoid cells infiltrating into the deep lamina propria and muscularis mucosae, whereas the superficial lamina propria was highly edematous with scant small lymphocytes. Immunohistochemical studies confirmed that both underlying atypical cells and superficial small lymphocytes were neoplastic, sharing an identical immunophenotype: positive for CD2, CD3, CD43, CD8, CD56, TIA-1 and granzyme B. Epstein-Barr virus-encoded small RNAs were found in both cells. The histologic findings were diagnostic of primary esophageal extranasal NK/T cell lymphoma. However, the patient developed bone marrow depression during chemotherapy and died of massive cerebral hemorrhage after the first cycle of chemotherapy. Primary esophageal extranodal NK/T cell lymphoma nasal type is extremely rare. We show the biphasic morphology of this disease, which highlights the importance of deep biopsy for accurate diagnosis.
authors.affiliation: From the Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University (Z-YY, Q-HC, X-FL); Department of Oncology, Nanfang Hospital of Southern Medical University (FL); Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (S-RL); Department of Dermatology and Skin Diseases Research Center, University of Alabama at Birmingham, AL, USA (C-ZL) and Department of Pathology, Guangzhou First People's Hospital, Guangzhou, China (S-HC).
authors.forename: Zi-Yin
authors.initials: ZY
authors.lastname: Ye
authors.forename: Qing-Hua
authors.initials: QH
authors.lastname: Cao
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.forename: Xiao-Fang
authors.initials: XF
authors.lastname: Lu
authors.forename: Shu-Rong
authors.initials: SR
authors.lastname: Li
authors.forename: Chang-Zhao
authors.initials: CZ
authors.lastname: Li
authors.forename: Shao-Hong
authors.initials: SH
authors.lastname: Chen
mesh_terms: D000328:Adult; D004938:Esophageal Neoplasms / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D054391:Lymphoma, Extranodal NK-T-Cell / Q000473:pathology*; D008297:Male