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Guan J, Lin W, Liu W, Hui D. Primary central nervous system extranodal NK/T-cell lymphoma, nasal type with CD20 expression: Case report and review of the literature. Neuropathology 2024; 44:222-229. [PMID: 37963650 DOI: 10.1111/neup.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Primary central nervous system (PCNS) extranodal NK/T-cell lymphoma, nasal type (ENKTCL), is an exceedingly rare tumor. To the best of our knowledge, only 27 cases and only one reported aberrant CD20 expression have been documented in the literature. Here we present a second case of PCNS ENKTCL with aberrant CD20 expression in a 43-year-old immunocompetent Chinese female. The patient presented with tremors, weakness in the right upper limb, and a slow reaction. Magnetic resonance imaging revealed multiple brain lesions. A histological examination revealed a diffuse distribution of intermediate-sized pleomorphic lymphocytes with angiocentric growth. The tumor cells expressed CD2, CD3, CD56, T-cell intracellular antigen-1, granzyme B, and Epstein-Barr virus-encoded RNAs (EBERs), with additional partial and weak CD20 and CD30 expression. Despite a confirmatory pathological diagnosis, the patient refused treatment and was discharged, ultimately dying from the disease. In the literature review, the clinical, immunohistochemical, EBERs, treatment, and prognostic features of PCNS ENKTCL were summarized. Although PCNS ENKTCT is extremely rare, it does occur and should always be included in differential diagnoses. CD20 expression should be evaluated routinely with relevant markers. The accumulation of cases is crucial for developing an effective treatment strategy for this rare and aggressive malignancy.
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Affiliation(s)
- Jiexia Guan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weizhen Lin
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weimin Liu
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dayang Hui
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Han Y, Wei S, Zhang Y, Wang L, Xu X. Extranodal nasal-type NK/T-cell lymphoma with CD20 positive: A case report and review of literature. INDIAN J PATHOL MICR 2024; 67:459-462. [PMID: 38391360 DOI: 10.4103/ijpm.ijpm_32_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/08/2022] [Indexed: 02/24/2024] Open
Abstract
ABSTRACT Extranodal nasal-type natural killer (NK)/T-cell lymphoma is a type of non-Hodgkin lymphoma. Neoplastic lymphocytes are positive for CD4, CD56, and CD20, a specific B-cell marker. CD20 positive NK/T-cell lymphoma is rare, with only nine reported cases. This paper reports a case of nasal-type NK/T-cell lymphoma with CD20 positivity in a 47-year-old woman. The patient presented with bilateral nasal congestion and bloody nasal cavity secretions for 2 months. Computed tomography revealed thickening of the nasal mucosa and posterior wall of the nasopharyngeal crest, and the left and right cervical lymph nodes were enlarged. On histopathology, the lesion was composed of medium-sized atypical lymphoid cells and vascular infringement. Immunohistochemical staining showed that the tumor cells were positive for CD20, CD3, CD56, and Epstein-Barr virus (EBV)-encoded RNA in situ hybridization. The patient was treated with radiotherapy for 2 months and is currently well.
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Affiliation(s)
- Yongliang Han
- Department of Pathology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Shufei Wei
- Department of Pathology, Jiujiang University Hospital, Jiujiang, China
| | - Yihang Zhang
- Department of Radiology, Jiujiang University Hospital, Jiujiang, China
| | - Liangliang Wang
- Department of Pathology, Jiujiang University Hospital, Jiujiang, China
| | - Xiao Xu
- Department of Pathology, Jiujiang University Hospital, Jiujiang, China
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Zhao B, Kim HJ, Tam L, Xiong W, Rosenfeld G. A Rare Case of Gastric Extranodal NK/T-Cell Lymphoma With Orbital Involvement. ACG Case Rep J 2024; 11:e01280. [PMID: 38425941 PMCID: PMC10901430 DOI: 10.14309/crj.0000000000001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
Gastric extranodal NK/T-cell lymphoma (ENKTL) is a rare presentation of a rare disease. We report a 33-year-old woman presenting with epigastric pain, nausea, and vomiting. Endoscopic examination revealed gastric and duodenal ulceration. Biopsy of the ulcers revealed ENKTL. The patient began treatment, but developed hemorrhagic shock from her ulcers and died. Gastric ENKTL is a rare disease that presents with gastric ulceration. It has a high rate of mortality, and treatment is challenging because of its aggressive nature and lack of high-quality data to guide therapy.
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Affiliation(s)
- Billy Zhao
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Jae Kim
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Landon Tam
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wei Xiong
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Greg Rosenfeld
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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Wu C, Shi L, Shi K, Wang Z, Zhang Y. A Case Report of Extranodal NK/T-Cell Lymphoma Misdiagnosed as Meibomitis. Ocul Immunol Inflamm 2023:1-4. [PMID: 37186811 DOI: 10.1080/09273948.2023.2201326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Extranodal natural killer/T-cell lymphoma (ENKTL) is a rare type of non-Hodgkin's lymphoma. This report presents a patient with the right lower eyelid ENKTL misdiagnosed as meibomitis repeatedly. CASE PRESENTATION A 48-year-old woman developed recurrent redness and swelling in right eyelid for 2 years. Three eyelid mass removal operations were performed in local hospitals, and the pathological examination suggested meibomitis. Physical examination showed an induration in the lateral lower eyelid of the right eye, local defect of the eyelid margin, mild entropion, redness and swelling of the surrounding tissues, and temporal bulbar conjunctiva hyperemia. The eyelid lesion was resected and ENKTL was diagnosed by specific immunohistochemical staining and in situ hybridization. The lymphoma resolved with chemotherapy and radiotherapy. The patient was still alive forty-one months after the last operation. CONCLUSION Our report demonstrates that recurrent eyelid redness and swelling might be a malignant tumor, and clinicians should be vigilant.
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Affiliation(s)
- Chao Wu
- Department of Ophthalmology, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Lu Shi
- Department of Ophthalmology, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Ke Shi
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zhiqiang Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Yulan Zhang
- Department of Ophthalmology, The Second Affiliated Hospital, Nanchang University, Nanchang, China
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Li S, Liu T, Liu H, Zhai X, Cao T, Yu H, Hong W, Lin X, Li M, Huang Y, Xiao J. Integrated driver mutations profile of chinese gastrointestinal-natural killer/T-cell lymphoma. Front Oncol 2022; 12:976762. [PMID: 36059700 PMCID: PMC9434212 DOI: 10.3389/fonc.2022.976762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background One of the most common nasal external sites in extranodal Natural Killer/T-cell lymphoma (NKTCL) is in the gastrointestinal (GI) system. Despite this, reports on gastrointestinal-Natural Killer/T-cell lymphoma (GI-NKTCL) are very few. To obtain a better understanding of this manifestation of NKTCL, we conducted a retrospective study on GI-NKTCL to analyze its clinical features, genomic changes and immune infiltration. Methods We retrospectively collected patients diagnosed with GI-NKTCL in the Sixth Affiliated Hospital of Sun Yat-sen University from 2010 to 2020. From this cohort we obtained mutation data via whole exome sequencing. Results Genomic analysis from 15 patients with GI-NKTCL showed that the most common driving mutations were ARID1B(14%, 2/15), ERBB3(14%, 2/15), POT1(14%, 2/15), and TP53(14%, 2/15). In addition, we found the most common gene mutation in patients with GI-NKTCL to be RETSAT(29%, 4/15) and SNRNP70(21%, 3/15), and the most common hallmark pathway mutations to be G2M checkpoint pathway (10/15, 66.7%), E2F targets (8/15, 53.3%), estrogen response late (7/15, 46.7%), estrogen response early (7/15, 46.7%), apoptosis (7/15, 46.7%) and TNFA signaling via NFKB (7/15, 46.7%). In the ICIs-Miao cohort, SNRNP7-wild-type (WT) melanoma patients had significantly prolonged overall survival (OS) time compared with SNRNP7 mutant type (MT) melanoma patients. In the TCGA-UCEC cohort, the patients with RETSAT-MT or SNRNP7-MT had significantly increased expression of immune checkpoint molecules and upregulation of inflammatory immune cells. Conclusions In this study, we explored GI-NKTCL by means of genomic analysis, and identified the most common mutant genes (RETSAT and SNRNP70), pathway mutations (G2M checkpoint and E2F targets) in GI-NKTCL patients. Also, we explored the association between the common mutant genes and immune infiltration. Our aim is that our exploration of these genomic changes will aid in the discovery of new biomarkers and therapeutic targets for those with GI-NKTCL, and finally provide a theoretical basis for improving the treatment and prognosis of patients with GI-NKTCL.
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Affiliation(s)
- Shanshan Li
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingzhi Liu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Medical Hematology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hailing Liu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pathology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
| | - Xiaohui Zhai
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Taiyuan Cao
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongen Yu
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wanjia Hong
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoru Lin
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Li
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Huang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pathology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- *Correspondence: Yan Huang, ; Jian Xiao,
| | - Jian Xiao
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Yan Huang, ; Jian Xiao,
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Li DJ, Kan YZ, Xu ZG, Kang H, Dong XM, Kong LF. [Extranodal nasal-type natural killer/T-cell lymphoma with aberrant expression of CD20: two cases report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:336-339. [PMID: 32447942 PMCID: PMC7364918 DOI: 10.3760/cma.j.issn.0253-2727.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D J Li
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
| | - Y Z Kan
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
| | - Z G Xu
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
| | - H Kang
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
| | - X M Dong
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
| | - L F Kong
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
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Huang Y, Chen S, Wei R, Guo X, Yang X, Cao Q, Yang Y, Yun J. CD20-positive extranodal NK/T cell lymphoma: clinicopathologic and prognostic features. Virchows Arch 2020; 477:873-883. [PMID: 32314054 DOI: 10.1007/s00428-020-02776-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 12/18/2022]
Abstract
Extranodal natural killer (NK)/T cell lymphoma (ENKTCL) with aberrant CD20 expression is extremely rare. Here, we describe the clinicopathologic features of 11 CD20-positive ENKTCLs from three institutions in China along with a literature review. Membranous expression of CD20 was identified in 1.29% (11/851) of ENKTCLs. CD20-positive ENKTCLs primarily occurred in extra-nasal sites (72.2%, 13/18) rather than in the nasal cavity (27.8%, 5/18). Most evaluated patients (71.4%, 10/14) presented ENKTCL at advanced stage IV. The percentage of CD20-positive tumor cells ranged from 20 to 90%, and the CD20 staining intensity was dimmer in tumor cells than in normal B cells. Among four cases with multiple biopsies, three cases showed discordant expression of CD20 between the disseminated and primary lesions. All evaluated cases were negative for other B cell markers, including PAX5, CD79a, and CD19, except for one case that showed focally positive for CD79a. Patients with CD20-positive ENKTCL more frequently had advanced diseases (stage III/IV: 70% vs 17%, p = 0.001), with older age (median age at diagnosis: 60 years vs. 43.5 years, p = 0.006) and had inferior outcome (median survival: 18.7 moths vs 36.0 moths, p = 0.017) compared with CD20-negative cases. Four nonsynonymous single nucleotide variants (C > T) and one stop-gain mutation (C > T) in the exonic region of CD20 gene (MS4A1) were detected in one of seven cases with target region next-generation sequencing. Thus, ENKTCL with aberrant CD20 expression is rare, tends to occur in older patients, and is characterized by a highly aggressive clinical course and poor outcomes. The mechanism underlying the expression of CD20 in ENKTC still remains unknown.
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Affiliation(s)
- Yuhua Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Shilu Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Rong Wei
- Department of Pathology, Second Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Xinjian Guo
- Department of Pathology, Hospital Affiliated to Qinghai University, Xining, Qinghai, People's Republic of China
| | - Xia Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Qinghua Cao
- Department of Pathology, The first affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Yu Yang
- Department of Pathology, Chinese Traditional Medical Hospital of Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Jingping Yun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China. .,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China.
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De Novo Testicular Extranodal NK/T-Cell Lymphoma: A Clinicopathologic Study of 21 Cases With Review of Additional 18 Cases in the Literature. Am J Surg Pathol 2020; 43:549-558. [PMID: 30589649 DOI: 10.1097/pas.0000000000001210] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although the testis is not uncommonly involved during the course of disease in both nasal and non-nasal extranodal NK/T-cell lymphoma (ENKTCL), only a few cases presenting initially with a testicular mass have been previously reported. These have been documented as case reports, rather than as study series. Because of its rarity, the clinicopathologic features and the prognosis of de novo testicular ENKTCL have not been well characterized. Clinicopathologic features of 21 cases of de novo testicular ENKTCL from 3 institutions in China were retrospectively analyzed with review of an additional 18 cases from the literature. De novo testicular ENKTCL accounted for 0.72% (21/2906) of all ENKTCL during the study period. The median age of patients with de novo testicular ENKTCL was 45 years (range, 21 to 79 y). Most (90.9%) cases occurred in Asians. All patients initially presented with testicular swelling and most (91.9%) had unilateral testicular masses. The majority (73.0%) of patients presented at Ann Arbor stage I/II. Expression of CD56 was found in 92.1% (35/38) of the available cases. Interestingly, aberrant expression of CD20 was found in the tumor cells in 10.3% (4/39) of cases. The majority of patients with follow-up data (24/30, 80%) had extratesticular involvement during the follow-up period (median follow-up, 6 months; range, 0.5 to 87 mo). Preferential sites of extratesticular involvement included lymph nodes, skin, contralateral testis, bone marrow, spleen, adrenal gland, and central nervous system. Of the 30 patients with survival data, 70% (22/30) of patients died of the disease. The 2-year overall survival of patients with de novo testicular ENKTCL was 23%, and the median survival was 9.5 months. Patients that presented with B symptoms showed a trend toward inferior overall survival (P=0.095). No statistical significance was found between patients with stage I/II and stage III/IV (P=0.783). De novo testicular ENKTCL tends to disseminate early, shows extremely poor outcome, and should be recognized as a highly aggressive form of ENKTCL. A portion of cases show aberrant expression of CD20, and accurate diagnosis as well as timely and optimal treatment are very important.
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Liu YN, Zhu Y, Tan JJ, Shen GS, Huang SL, Zhou CG, Huangfu SH, Zhang R, Huang XB, Wang L, Zhang Q, Jiang B. Extranodal natural killer/T-cell lymphoma (nasal type) presenting as a perianal abscess: A case report. World J Clin Cases 2019; 7:992-1000. [PMID: 31119144 PMCID: PMC6509261 DOI: 10.12998/wjcc.v7.i8.992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/21/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Extranodal natural killer (NK) T-cell lymphoma (ENKTL), nasal type is a rare subtype of extranodal non-Hodgkin lymphoma characterized by vascular damage and necrosis. The lesions usually present in the nasal cavity and adjacent tissues, however, the disease originates from the gastrointestinal or genitourinary tract in 25% of cases. Since rectal involvement in ENKTL is rare, rectal symptoms in the course of ENKTL are often misdiagnosed and considered to be related to benign diseases such as rectal fistula or perianal abscess.
CASE SUMMARY We report the case of a 24-year-old Han Chinese female who initially presented with a perianal abscess that was subsequently diagnosed as nasal type ENKTL. Due to typical perianal pain, perianal abscess was diagnosed and surgical incision and drainage were performed. After recurrent, severe anal hemorrhages leading to hypovolemic shock and multiple surgeries, a diagnosis of ENKTL was made. The patient’s condition gradually deteriorated, and she died shortly after initiation of chemotherapy.
CONCLUSION Systemic and neoplastic diseases should be included in the differential diagnosis of any potentially benign perianal abscess complicated with recurrent hemorrhages.
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Affiliation(s)
- Yan-Ni Liu
- Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Yong Zhu
- Department of Colorectal Surgery, The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
| | - Jia-Jun Tan
- Department of Colorectal Surgery, The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
| | - Guang-Shu Shen
- Department of Pathology, The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
| | - Shu-Liang Huang
- Department of Medical Imaging, The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
| | - Chun-Gen Zhou
- Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Shao-Hua Huangfu
- Department of Colorectal Surgery, The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
| | - Rui Zhang
- Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Xiao-Bo Huang
- Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Ling Wang
- Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Qi Zhang
- Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Jiang
- Department of Colorectal Surgery, The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
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Liao PH, Chou SC, Huang WT, Su YZ, Wang MC, Chuang SS. Recurrent monomorphic epitheliotropic intestinal T-cell lymphoma with aberrant CD20 expression: An implication for anti-CD20 (rituximab) antibody therapy? Pathol Int 2018; 68:712-714. [PMID: 30402988 DOI: 10.1111/pin.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Pi-Han Liao
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung-Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Shih-Cheng Chou
- Department of Pathology, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Wan-Ting Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung and College of Medicine, Kaohsiung and Chang Gung University, Kaohsiung, Taiwan
| | - Ying-Zhen Su
- Department of Pathology, Chi-Mei Medical Center Tainan, Taiwan
| | - Ming-Chung Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung-Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
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Pan ST, Ko YH, Tan SY, Chuang SS. Primary cutaneous peripheral T-cell lymphoma with a late relapse solely in the ileum mimicking monomorphic epitheliotropic intestinal T-cell lymphoma. Pathol Res Pract 2018; 214:2106-2109. [PMID: 30477646 DOI: 10.1016/j.prp.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/13/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary cutaneous peripheral T-cell lymphomas (PC-PTCLs) are classified into mycosis fungoides (MF) and other rare specific types; and those do not fit into any specific entities are designated as PTCL, not otherwise specified (NOS), an aggressive neoplasm. Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is an aggressive primary intestinal T-cell lymphoma with enteropathy in the non-neoplastic mucosa. We report a rare case of PC-PTCL-NOS with a late relapse solely in the ileum after complete remission. We discuss the importance of evaluating enteropathy, megakaryocyte-associated tyrosine kinase (MATK) immunostaining, and the implication of clonal relationship of metachronous lymphomas. CASE REPORT We reviewed the histopathology and immunohistochemistry of the skin tumor from a 68-year-old female and the relapsed intestinal T-cell lymphoma. The tumor cells "trans-regressed" from large and pleomorphic in the skin to small/medium-sized cells with clear cytoplasm in the ileum; and furthermore, there was immunophenotypic alteration. However, there was no enteropathy in the non-tumoral ileal mucosa adjacent to the tumor proper and both the cutaneous and ileal tumors were negative for MATK. Clonality study showed clonal TRG and TRB rearrangement with identical band sizes of the amplicons, confirming primary cutaneous tumor with a late relapse in the ileum. CONCLUSIONS Although PC-PTCL-NOS is an aggressive neoplasm, rare cases such as this might have a long-term survival. Furthermore, the late relapse mimicking MEITL is intriguing and exceptional, in spite the fact that MEITL is a primary intestinal T-cell lymphoma with a typical histopathology and immunophenotype. Detailed clinicopathological and molecular studies are mandatory to elucidate the clonal relationship of metachronous lymphomas, as this has important clinical implication for treatment. Evaluation of the non-tumoral intestinal mucosa for enteropathy and immunostaining for MATK might help to differentiate a mimicker from a true MEITL.
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Affiliation(s)
- Shien-Tung Pan
- Department of Pathology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Young-Hyeh Ko
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Yong Tan
- Department of Pathology, Singapore National University, Singapore, Singapore
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Pathology, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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12
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Li D, Fu F, Lian L. Primary central nervous system extranodal nasal-type natural killer/T-cell lymphoma with CD20 expression. Neuropathology 2017; 38:198-204. [PMID: 29063643 DOI: 10.1111/neup.12438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Dujuan Li
- Department of Pathology; Henan Provincial People's Hospital (People's Hospital of Zhengzhou University); Zhengzhou China
| | - Fangfang Fu
- Department of Radiology; Henan Provincial People's Hospital (People's Hospital of Zhengzhou University); Zhengzhou China
| | - Lifei Lian
- Department of Neurology, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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13
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Haverkos BM, Pan Z, Gru AA, Freud AG, Rabinovitch R, Xu-Welliver M, Otto B, Barrionuevo C, Baiocchi RA, Rochford R, Porcu P. Extranodal NK/T Cell Lymphoma, Nasal Type (ENKTL-NT): An Update on Epidemiology, Clinical Presentation, and Natural History in North American and European Cases. Curr Hematol Malig Rep 2017; 11:514-527. [PMID: 27778143 DOI: 10.1007/s11899-016-0355-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT) is an aggressive extranodal non-Hodgkin lymphoma most commonly occurring in East Asia and Latin America but with increasing incidence in the United States. Data on epidemiology, disease presentation, and outcome for European and North American ("Western") cases are very limited. We review published landmark clinical studies on ENKTL-NT in the West and report in detail recent data, including our institutional experience. RECENT FINDINGS We highlight key observations in its epidemiology, natural history, and trends in clinical management. In the USA, ENKTL-NT is more common among Asian Pacific Islanders (API) and Hispanics compared to non-Hispanic whites. Published studies indicate less heterogeneity in clinical presentation in Western ENKTL-NT compared to Asian patients. While there is variation in age at diagnosis, presence of antecedent lymphoproliferative disorders, and outcomes among racial/ethnic groups, the universal association of ENKTL-NT with EBV and the poor response of this neoplasm to anthracycline-based therapy is consistent across all geographic areas. Data on epidemiology, disease presentation, and clinical outcomes in mature T cell and NK cell (T/NK cell) neoplasms, including ENKTL-NT, in Europe and North America are very limited. As the classification and diagnostic characterization of the currently recognized T/NK cell lymphoma disease entities continue to evolve, gaps and inconsistencies in data reporting across different studies are being recognized. Despite these limitations, several studies from the USA suggest that the incidence of ENKTL-NT is higher in Asian Pacific Islanders (API) and non-white Hispanics and that outcomes may be worse in non-whites. However, the universal association of ENKTL-NT with Epstein-Barr virus (EBV) across all ethnic groups suggests a common pathogenesis. Given the overlap between the entities included in the category of T/NK cell neoplasms, there is a need to further define biological and clinical differences that may affect diagnosis, treatment, and outcome.
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Affiliation(s)
- Bradley M Haverkos
- Division of Hematology, University of Colorado, 1665 Aurora Ct., Mail Stop F754, Aurora, CO, 80045, USA.
| | - Zenggang Pan
- Department of Pathology, University of Colorado, Aurora, CO, USA
| | - Alejandro A Gru
- Department of Pathology and Dermatology, University of Virginia, Charlottesville, VA, USA
| | - Aharon G Freud
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | | | - Meng Xu-Welliver
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Brad Otto
- Department of Otolaryngology, Ohio State University, Columbus, OH, USA
| | - Carlos Barrionuevo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasticas (I.N.E.N.), Lima, Peru
| | - Robert A Baiocchi
- Division of Hematology and Comprehensive Cancer Center, Ohio State University, 320 West 10th Avenue, Columbus, OH, 43210, USA
| | - Rosemary Rochford
- Department of Immunology and Microbiology, University of Colorado, Aurora, CO, USA
| | - Pierluigi Porcu
- Division of Hematology and Comprehensive Cancer Center, Ohio State University, 320 West 10th Avenue, Columbus, OH, 43210, USA
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Yang H, Fu G, Liu J, Da Z, Cheng X, Chen C, Li Y, Fu B, Li X. Clinical analysis of 42 cases of EBV-positive mature T/NK-cell neoplasms. Exp Ther Med 2017; 14:567-574. [PMID: 28672968 PMCID: PMC5488386 DOI: 10.3892/etm.2017.4531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/31/2017] [Indexed: 12/22/2022] Open
Abstract
The pathogenesis of Epstein-Barr virus-positive (EBV+) mature T-cell and natural killer (NK)-cell neoplasms is challenging to understand. The clinical features are diverse, with no typical manifestation. Therefore, it is important to analyze the association of the clinical characteristics and prognoses of patients with various factors associated with EBV+ T/NK-cell neoplasms, particularly extranodal NK/T cell lymphoma, systemic EBV+ T/NK cell lymphoproliferative disorders, aggressive NK cell leukemia and EBV+ peripheral T-cell lymphoma. Therefore, 42 cases of EBV+ T/NK-cell neoplasms with information on age, gender, fever, LDH level, complete blood count (CBC) and immunophenotype (CD5/CD20) were retrospectively analyzed to examine the clinical features, prognoses and related factors. It was found that patients ≤60 years old accounted for 86% of cases. The frequency of stage III/IV disease was higher in groups with pancytopenia (P=0.005), high LDH level (P=0.020), CD5-expression status (P=0.031) and fever (P=0.024). There were significant differences in the mean International Prognostic Index (IPI) scores according to the presence or absence of fever (P=0.022), elevated or normal lactose dehydrogenase (LDH) levels (P=0.001), and pancytopenia or normal complete blood count (CBC; P=0.046). Analysis of overall survival showed that CD5 expression, CBC, IPI scores and LDH levels were factors associated with OS. CD5 expression (P=0.003), CBC (P=0.003) and IPI scores (P=0.017) were identified to be important risk factors on the basis of Cox regression analysis. The mean survival time was longer in the CD5+, CD20+ and normal CBC groups, and there was no clear difference in survival time according to LDH level or fever. In summary, CD5 and CD20 may be prognostic factors in EBV+ T/NK lymphoid neoplasms, and CBC and fever are most likely to influence the IPI score and Ann Arbor stage.
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Affiliation(s)
- Haiyan Yang
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Gan Fu
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Jia Liu
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Zhenzhen Da
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiaoye Cheng
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Cong Chen
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Yan Li
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Bin Fu
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiaolin Li
- Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
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