Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2019; 7(8): 992-1000
Published online Apr 26, 2019. doi: 10.12998/wjcc.v7.i8.992
Extranodal natural killer/T-cell lymphoma (nasal type) presenting as a perianal abscess: A case report
Yan-Ni Liu, Yong Zhu, Jia-Jun Tan, Guang-Shu Shen, Shu-Liang Huang, Chun-Gen Zhou, Shao-Hua Huangfu, Rui Zhang, Xiao-Bo Huang, Ling Wang, Qi Zhang, Bin Jiang
Yan-Ni Liu, Chun-Gen Zhou, Rui Zhang, Xiao-Bo Huang, Ling Wang, Qi Zhang, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
Yong Zhu, Jia-Jun Tan, Shao-Hua Huangfu, Bin Jiang, 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
Author contributions: Liu YN and Zhu Y contributed equally to this work; Liu YN, Tan JJ, Huangfu SH, Zhang R, Huang XB, and Wang L collected and analyzed the data, and drafted the manuscript; Shen GS and Zhang Q analyzed the results of diagnostic imaging; Huang SL and Zhou CG performed pathological evaluations; Liu YN, Zhu Y, and Jiang B wrote and revised the manuscript; all authors read and approved the final version of the manuscript.
Supported by the Nanjing Health Bureau Project, No. ZKX17034; Nanjing Traditional Chinese Medicine of Medical Conversion Base, No. ZHZD201802; and The 13th Five-Year Plan for Training Young Health Personnel in Nanjing, No. NWQR-201702.
Informed consent statement: The study was approved by the Medical Ethics Committee of The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, and written informed consent was obtained from the family members of the patient.
Conflict-of-interest statement: All authors declare no conflict of interest.
CARE Checklist (2016) statement: This case report was written in accordance with the CARE (2016) guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: Bin Jiang, PhD, Chief Doctor, Director, National Center of Colorectal Disease, The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China. jbfirsth@aliyun.com
Telephone: +86-18951755051
Received: December 19, 2018
Peer-review started: December 19, 2018
First decision: January 19, 2019
Revised: February 21, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: April 26, 2019
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.

Keywords: Extranodal natural killer T-cell lymphoma, Perianal abscess, Lymphoma, Rectal involvement, Case report

Core tip: The case highlights the need to include systemic and neoplastic diseases in the differential diagnosis of any potentially benign perianal abscess complicated with recurrent hemorrhages. A 24-year-old Han Chinese female, initially diagnosed with perianal abscess, underwent the surgical incision and drainage. The symptoms and the results of imaging, laboratory analysis, and colonoscopic biopsy were non-specific. After recurrent, severe anal hemorrhages leading to hypovolemic shock and multiple surgeries, a final diagnosis of extranodal natural killer/T cell lymphoma was made based on the result of histopathological examination. The patient’s condition gradually deteriorated, and she died shortly after initiation of chemotherapy.