Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2020; 26(27): 3989-3997
Published online Jul 21, 2020. doi: 10.3748/wjg.v26.i27.3989
Intestinal NK/T cell lymphoma: A case report
Hui Li, Wen Lyu
Hui Li, Wen Lyu, Department of Gastroenterology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: Li H and Lyu W designed this case report; Lyu W performed the endoscopy examination; Li H followed the patient, recorded her medical information, and wrote the paper.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wen Lyu, MD, Chief Doctor, Director, Department of Gastroenterology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 4, Xueshi Road, Shangcheng District, Hangzhou 310000, Zhejiang Province, China. lihui-cy@163.com
Received: March 31, 2020
Peer-review started: March 31, 2020
First decision: April 29, 2020
Revised: June 9, 2020
Accepted: June 23, 2020
Article in press: June 23, 2020
Published online: July 21, 2020
Abstract
BACKGROUND

The incidence of intestinal NK/T cell lymphoma (NKTCL) is extremely low, and the clinical symptoms are atypical, which makes it difficult to distinguish this disorder from Crohn's disease (CD), T lymphocyte proliferative disease, and other immune disorders. The misdiagnosis rate is high, and the patient's prognosis is poor.

CASE SUMMARY

In this case, the patient had repeated high fever, colonoscopy revealed multiple ulcers, and the initial diagnosis was CD. The patient’s condition did not improve after treatment with hormones and infliximab, and she eventually died. Positron emission tomographic-computed tomographic and B-ultrasound were performed in our hospital and showed that multiple lymph nodes were enlarged. Immunohistochemi-stry showed that CD3 and Epstein-Barr virus encoded RNA expression was positive. Colonoscopy, tissue biopsy, and histopathology showed intestinal focal mucosal infiltration of heterotypic lymphocytes with an abnormal immune phenotype. On the basis of the patient’s medical history, auxiliary examination, and pathological findings, digestive physicians and pathologists gave the diagnosis of NKTCL.

CONCLUSION

Clinicians need to improve their comprehensive knowledge of NKTCL, and combination of clinical symptoms, histological characteristics, as well as colonoscopy biopsies should be considered to improve the diagnosis and thereby reduce misdiagnosis.

Keywords: NK/T cell lymphoma, Indolent T lymphocyte proliferative disease, Crohn's disease, Endoscopy, Misdiagnosis, Case report

Core tip: The incidence of intestinal NK/T cell lymphoma (NKTCL) is extremely low, and the clinical symptoms are atypical. The misdiagnosis rate is high, and the patient's prognosis is poor. It is commonly caused by Epstein-Barr virus infection. At present, the etiology of this disease is unclear. The patient in this case was eventually diagnosed with intestinal NKTCL. The patient’s condition did not improve after treatment with hormones and infliximab, and she eventually died. This case reminds us that more potential molecular markers need to be explored. The molecular regulatory network needs to be supplemented to help with the differential diagnosis. Clinicians and pathologists need to improve their awareness of this disease and reduce the rate of misdiagnosis.