Lymph node involvement by enteropathy-like indolent NK-cell proliferation
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BRIEF REPORT
Lymph node involvement by enteropathy-like indolent NK-cell proliferation Jean-Louis Dargent 1 & Nicolas Tinton 2 & Mounir Trimech 3 & Laurence de Leval 3 Received: 2 June 2020 / Revised: 17 June 2020 / Accepted: 7 July 2020 # The Author(s) 2020
Abstract Natural killer (NK)-cell enteropathy (NKCE) and lymphomatoid gastropathy (LG) are closely related lymphoproliferative disorders (LPDs) composed of mature and Epstein–Barr virus (EBV)-negative NK-cells. Although these uncommon and indolent lymphoid proliferations mostly arise within the gastrointestinal (GI) tract as their designations implies, a few cases have been reported outside the GI tract. We hereby describe a unique case of lymph node infiltration by such EBV-negative NK-cell proliferation fortuitously found during routine examination of a gallbladder resected for biliary lithiasis. The histologic, phenotypic, and molecular features of this NK-cell proliferation, which were very similar if not identical to those previously reported in NKCE or LG, suggest that similar indolent EBV-negative NK-cell LPDs may also occasionally involve lymph nodes. Keywords Indolent NK-cell lymphoproliferative disorder . NK-cell enteropathy . Lymphomatoid gastropathy . Lymph node . Gallbladder . Gastrointestinal
Introduction
Case report
Several cases of a particular Epstein–Barr virus (EBV)negative natural killer (NK)-cell proliferation occurring mainly in the gastrointestinal (GI) tract and following an indolent course have been recently reported [1–16]. The clinico-pathologic spectrum of this rare lymphoproliferative disorder (LPD), initially described as lymphomatoid gastropathy and more commonly referred to as NK-cell enteropathy (NKCE) [1–16], remains not fully characterized. Herein, we describe an EBV-negative NK-cell proliferation that was fortuitously found in the cystic duct lymph node of a cholecystectomy.
A 37-year-old Caucasian male with no previous medical history underwent laparoscopic cholecystectomy for symptomatic biliary lithiasis. The gallbladder contained gallstones, had a moderately thickened wall, and no obvious mucosal lesion. A 1.3-cm lymph node was adjacent to the cystic duct, which was free of stone. Histologically, the gallbladder showed hyperplastic and inflammatory changes consistent with xanthogranulomatous cholecystitis, and the cystic duct was normal. Beside benign reactive changes with B cell follicular hyperplasia, the lymph node was partially obliterated by a relatively circumscribed and vaguely nodular infiltrate of monotonous medium-sized cells with moderately abundant pale cytoplasm (Fig. 1a–b). No cytoplasmic granules were visible. Nuclei were round to oval with slightly irregular contours, somewhat open chromatin and inconspicuous nucleoli (Fig. 1c). There were rare apoptotic bodies, few mitoses, and scattered histiocytes. By immunohistochemistry, the pale cells were positive for CD2, cytoplasmic CD3 (± ), CD7, CD56, perforin, granzyme B (± ) and T-cell intracellular antigen (TIA)-1, and negative for T-cell receptor β (TC
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