Korean J Gastroenterol.  2009 Sep;54(3):174-179. 10.4166/kjg.2009.54.3.174.

A Case of CD56+ Extranodal NK/T-cell Lymphoma, Nasal Type, Presenting as a Duodenal Ulcer Bleeding

• Yu JH
• Choi KD
• Koh YW
• Choi WJ
• Song HJ
• Lee GH
• Jung HY
• Kim JH

• KMID: 1775954
• DOI: http://doi.org/10.4166/kjg.2009.54.3.174

Abstract

Extranodal NK/T-cell lymphoma is a recently recognized distinct entity within the World Health Organization classification of lymphoid tumors. It is relatively prevalent in Asian and South American populations. It most commonly occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. Among these, extranodal NK/T-cell lymphoma of the gastrointestinal tract has shown an aggressive clinical course. We report a case of CD56+ extranodal NK/T-cell lymphoma presenting as a duodenal ulcer bleeding. A 62-year-old male patient presented with melena and abdominal pain. Endoscopic examination of the upper gastrointestinal tract showed the duodenal ulcer covered by blood clot. Pathologic examination revealed the diffuse infiltration of atypical lymphocytes with an angiocentric growth pattern, which was positive for CD3, CD56, and granzyme. The patient showed rapid deteriorating clinical course and died on day 14 after admission. Thus, we report this case with the review of literatures.

Keyword

NK/T-cell lymphoma; Duodenum; Bleeding

MeSH Terms

Antigens, CD3/metabolism
Antigens, CD56/*metabolism
Bone Marrow/pathology
Duodenal Ulcer/*diagnosis
Herpesvirus 4, Human/genetics/metabolism
Humans
Lymphoma, Extranodal NK-T-Cell/*diagnosis/pathology
Male
Middle Aged
Peptic Ulcer Hemorrhage/*diagnosis
Tomography, X-Ray Computed

Figure

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  Fig. 1. Endoscopic findings of duodenal NK/T-cell lymphoma. (A) At the duodenal bulb, A large sized ulcer with bleeding was noted, (B) After 3 days, the duodenal ulcer was covered by yellowish exudate without sign of active bleeding.

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  Fig. 2. Pathologic findings of NK/T-cell lymphoma. (A) Duodenal mucosa showing diffuse subepithelial infiltration atypical lymphocytes into the lamina propria (H&E stain, ×40), (B) Angio-centeric invasion of atypical lymphoid cells (H&E stain, ×400).

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  Fig. 3. Immunohistochemical staining of NK/T-cell lymphoma and Epstein-Barr virus (EBV) in situ hybridization. (A) The tumor cells showed diffuse cytoplasmic immunopositivity for CD3 (×400), (B) The tumor cells showed diffuse immunopositivity for CD56 (×400), (C) In situ hybridization for EBV showing positive signals in the tumor cells (×400).

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  Fig. 4. Abdominal CT finding showed enlarged pancreas head and bilateral adrenal mass.

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  Fig. 5. Bone marrow biopsy. (A) The neoplastic lymphoid cells showed small to medium size, round or irregular shape, clumped nuclear chromatin, small amount of deep blue cytoplasm, and a few coarse cytoplasmic granules of some cells in the bone marrow aspirate (Wright stain, ×1,000), (B) Bone marrow biopsy showed numerous positive cells on EBV in situ hybridization (×400).

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