Impaired lymphocyte reactivity against tumour cells in patients with Crohn's disease

Mucosa-associated lymphoid tissue lymphoma simulating Crohn's disease: A case report

BACKGROUND

Differential diagnosis between extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and inflammatory bowel disease is mainly based on histopathologic evaluation of intestinal biopsies, although there is no single definitive diagnostic investigation and that circumstance can lead to misdiagnosis in particular cases. Herein we present a rare, ulcerative form of marginal zone lymphoma which mimics the Crohn's disease (CD) of upper digestive tract.

CASE SUMMARY

A 50-year-old man was presented with recurrent episodes of malaise and melena also weight loss. Enteroscopy of the small bowel demonstrated an ulcer in the jejunum. Microscopically, biopsies showed lymphoplasmacytic infiltrate. Diagnosis of CD was made. Primary treatment consisted of prednisone and azathioprine and was followed by azathioprine 100 mg per day with good clinical response in the following 2 years until relapse. At this time the results of endoscopic biopsies derived from proximal wall of stomach revealed Helicobacter pylori-negative marginal zone lymphoma of the gastric fundus. Immunophenotyping confirmed atypical CD20-positive cell population. Based on these biopsies, marginal zone lymphoma of mucosa-associated lymphoid tissue was diagnosed. Unfortunately, the contact with the patient was lost until one year later he was hospitalized with nausea, vomiting and severe pain because of gastrointestinal perforation. Four months later after laparotomy, the patient was treated with a course of chemotherapy. Complete remission was observed following 6 cycles of treatment.

CONCLUSION

This case report highlights the clinical relevance of knowledge and awareness of marginal zone lymphoma simulating CD.

A Burkitt's Lymphoma Case Mimicking Crohn's Disease: A Case Report

Lymphomas are solid tumors that arise from lymphoid tissue and present themselves as Hodgkin's or non-Hodgkin's lymphoma. Particularly gastrointestinal lymphomas can be clinically confused with other gastrointestinal tumors as well as with diffuse and inflammatory bowel disease. Early diagnosis and treatment bear vital importance in the management of lymphomas due to their high proliferation rates. In this report, we are presenting a case which initially displayed clinical and radiological signs of Crohn's disease, but was eventually diagnosed as Burkitt's lymphoma by laparotomy, and also we aim to underscore the importance of differential diagnosis.

Carcinosarcoma of ileum in regional enteritis

A biphasic malignant neoplasm, carcinosarcoma, arose in a segment of ileum involved with regional enteritis. The tumor spread throughout the abdomen, and the patient died nine months after diagnosis. The spectrum of intraepithelial dysplasia, carcinoma with varying degrees of differentiation, and sarcomatous-appearing elements suggests that the histogenesis of this tumor is epithelial. This report provides further documentation of the relationship between regional enteritis and unusual neoplasms of the intestine.

Alteration in T lymphocyte subpopulations in inflammatory bowel disease

Peripheral blood mononuclear cells from thirty-one patients with inflammatory bowel disease (ulcerative colitis and Crohn's disease) were analysed for the proportions and absolute numbers of total T cells, and for the T cell subpopulations carrying Fc receptors for either IgM (Tmu cells) or IgG (T gamma cells). Twenty-six control subjects were studied simultaneously. Total T cell numbers were normal in patients with inflammatory bowel disease but there was a marked reduction in the proportion and absolute numbers of Tmu cells in patients, whether their disease was active or in remission. T gamma cells were normal. Simultaneous assessment of lymphocyte response to mitogens in vitro was performed in a group of patients. Responses to phytohaemagglutinin, concanavalin A and pokeweed mitogen were decreased and a positive correlation was found between the number of circulating Tmu cells and the responses to mitogens in vitro. These studies demonstrate that despite the presence of normal numbers of total T cells in inflammatory bowel disease, there is a marked imbalance in T cell subpopulations that correlates with mitogen responsiveness. This imbalance provides a possible cellular basis for the defect in cell-mediated immunity seen in these patients.

Sarcoidosis: correlation of delayed hypersensitivity, MLC reactivity and lymphocytotoxicity with disease activity

Delayed skin reactivity to a battery of antigens was assessed for a series of sarcoidosis patients and closely matched controls. It was compared with the proliferative and cytotoxic capacity of corresponding blood lymphocyte preparations after challenge in mixed lymphocyte culture with an allogeneic lymphoma cell line.

Skin anergy to all antigens tested was found only within the patient group having definitely active disease. These patients also showed depression of lymphocyte proliferative response in the in vitro test system as compared to matched controls and to patients with apparently inactive disease. Both of these differences were statistically significant. Skin reactivity to tuberculin was significantly depressed for the whole sarcoidosis group (both active and inactive) as compared to the control group and significant impairment of capacity to develop cytotoxicity in vitro was also found in comparison of these same groups.

The results obtained confirm the association of impaired delayed skin hypersensitivity in sarcoidosis with diminished lymphocyte reactivity in vitro, especially when the disease is active. The reduced cytotoxic capacity of sarcoid lymphocytes in vitro may reflect a comparable in vivo impairment and partly explain the depressed skin tests and also contribute to the protracted nature of the disease because of failure to eradicate the postulated `sarcoid agent'.