title: [Discordant lymphoma of duodenal EBV-positive peripheral T-cell lymphoma not otherwise specified and ileal diffuse large B-cell lymphoma].
abstract: A 79-year-old woman was admitted with a 5-kg weight loss and anorexia. Computed tomography showed diffuse lymphadenopathy, and thickening of the duodenal and ileal walls. The patient then underwent biopsy of these sites. Pathological examination revealed duodenal Epstein-Barr virus (EBV)-positive peripheral T cell lymphoma-not otherwise specified (PTCL-NOS) and EBV-negative ileal diffuse large B-cell lymphoma (DLBCL) to be present simultaneously. Combination chemotherapy including rituximab produced a reduction of the duodenal EBV-positive PTCL-NOS lesion, but had no effect on the EBV-negative ileal DLBCL lesion. Thereafter, new lymphadenopathy, high fever, and lactate dehydrogenase (LD) elevation developed, complicated by pneumonia. The patient died due to rapid deterioration of the lymphoma and pneumonia on day 108 after initiation of treatment. EBV-positive PTCL-NOS is reportedly rare and the prognosis is poor. Moreover, EBV-negative ileal DLBCL was diagnosed simultaneously. This case is considered to have had an extremely rare discordant lymphoma, although the exact etiology of its development remains unknown. We speculate that age-related disorders of the immune system and HCV infection may have been associated with the pathogenic mechanism of lymphomagenesis in this case.
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital.
authors.forename: Taro
authors.initials: T
authors.lastname: Kurihara
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sumi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kaiume
authors.forename: Wataru
authors.initials: W
authors.lastname: Takeda
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kirihara
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sato
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Ueki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hiroshima
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ueno
authors.forename: Naoaki
authors.initials: N
authors.lastname: Ichikawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Asano
authors.forename: Masahide
authors.initials: M
authors.lastname: Watanabe
authors.forename: Hikaru
authors.initials: H
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D007078:Ileal Neoplasms / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000821:virology; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy / Q000821:virology; D009378:Neoplasms, Multiple Primary / Q000821:virology