A Case Report of NK-Cell Lymphoproliferative Disease With a Wide Involvement of Digestive Tract Develop Into Epstein-Barr Virus Associated NK/T Cell Lymphoma in an Immunocompetent Patient

Abstract

Epstein-Barr virus (EBV) plays an important role in various diseases. EBV-associated lymphoproliferative disease (LPD) is a rare disease with a canceration tendency. It is difficult to differentiate LPD with involvement of digestive tract from Crohn disease due to similar clinical and endoscopic manifestations. We present a case report of multiple ulcers with esophagus, small bowel and the entire colon involved, proved to be NK-Cell LPD, developed into EBV-associated NK/T Cell lymphoma, in an immunocompetent man who was initially misdiagnosed as Crohn disease.This report underscores that intestinal ulcers should be cautiously diagnosed, for it sometimes could be a precancerous lesion.

FIGURE 1

(A) An enhanced small intestine computed tomography shows segmental wall of right colon, ileocecal, and terminal ileum thickened with multiple small lymph nodes seen. (B) Gastroscopy found rough mucosa with a longitudinal ulcer on the lower esophagus. Colonoscopy revealed multiple jumping ulcers in the terminal ileum (C) and the entire colon (D).

FIGURE 2

Microscope findings of the ascending colonic mucosa biopsy (A) and esophagus biopsy (200×) (B) in HE stain (400×).

FIGURE 3

Histologic findings of the lymphoma tissue under the microscope. (A) The cells are large with irregularly shaped or angulated nuclei and a variable amount of cytoplasm (HE stain, 400×). (B) The cells in this case diffusely express CD56 (magnification, 400×). (C) The cells express Ki67 (magnification, 400×). (D) The cells express EBER (magnification, 400×).

FIGURE 4

Immunohistochemistry results of CD56 expression (A and B), Ki67 expression (C and D) and EBER expression (E and F) in the ascending colonic mucosa biopsy (A, C, and E) and esophagus biopsy (B, D, and F) (magnification, A in 200× and others in 400×).