Epstein-Barr virus associated T-cell lymphoproliferative disease misdiagnosed as ulcerative colitis: a case report.
Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disease (LPD) is not uncommon in China, but gastrointestinal involvement is very rare. We report on an immunocompetent patient with EBV-associated T-cell LPD of the colon. The 26-year-old man was initially misdiagnosed with ulcerative colitis (UC). A colon biopsy revealed the presence of small to medium-sized lymphoid cells infiltrating the intestinal wall. The neoplastic cells expressed CD3, CD5, and granzyme B, not CD56. EBV-encoded small ribonucleic acid was detected in the tumor cells of the colon as well as the lymph node, and the T-cell receptor gene rearrangement result displayed δ gene monoclonal rearrangement. The patient died 2 moths after the diagnosis. The clinical course of EBV-associated T-cell LPD is aggressive and the prognosis is poor, the wrong diagnosis may delay treatment. Therefore, we should be very careful to prevent misdiagnosis. When patients have multiple intestinal ulcers that are not typical of UC and the clinical course is unusual, although morphology looks like inflammatory change, pathologist should consider the possibility of EBV-associated LPD. The treatment strategy and prognosis of these two diseases are different.
Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China.
Xiaodan
X
Zheng
Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China.
Jianlan
J
Xie
Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China.
Xiaoge
X
Zhou
D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D003106:Colon / Q000737:chemistry / Q000473:pathology / Q000821:virology*; D003110:Colonic Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000235:genetics / Q000821:virology; D003951:Diagnostic Errors; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism / Q000821:virology; D017809:Fatal Outcome; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism / Q000821:virology; D008297:Male; D025202:Molecular Diagnostic Techniques; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000235:genetics; D013601:T-Lymphocytes / Q000737:chemistry / Q000473:pathology / Q000821:virology*; D013997:Time Factors
D014408:Biomarkers, Tumor; D012367:RNA, Viral
Epstein-Barr virus; T cell; lymphoproliferative disease; ulcerative colitis