Rare Natural Killer Cell Lymphoma Found During Surveillance Endoscopy
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Rare Natural Killer Cell Lymphoma Found During Surveillance Endoscopy Maqsood Khan & Srinadh Komanduri
Published online: 28 August 2009 # Humana Press Inc. 2009
Abstract Introduction Non-Hodgkin’s lymphoma is the sixth leading cause of cancer death in the USA and comprises 2–3% of primary neoplasms. Natural killer (NK)/T cell lymphomas are subtypes of non-Hodgkin’s lymphoma and are aggressive neoplastic disorders with frequent extranodal presentations. Clinically, most cases of aggressive NK cell lymphomas present in young males with massive hepatosplenic infiltration. The upper aerodigestive tract is the most common site of presentation. Case Report NK/T cell lymphomas are subtypes of nonHodgkin’s lymphoma and are aggressive. Case Discussion Here we describe an unusual case of nonHodgkin’s NK/ T cell lymphoma of colon and stomach found during surveillance upper endoscopy followed by a subsequent colonoscopy. Keywords natural killer cell lymphoma . non-Hodgkin's lymphoma . gatrointestinal lymphoma
Introduction Non-Hodgkin’s lymphoma is the sixth leading cause of cancer death in the USA and comprises 2–3% of primary M. Khan (*) Department of Gastroenterology, Hepatology & Nutrition, Clinical Nutrition Fellow at Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH 44195, USA e-mail: [email protected] e-mail: [email protected] S. Komanduri Department of Gastroenterology, NorthWestern University Medical Center, Chicago, IL, USA
neoplasms. The gastrointestinal tract is the most commonly involved extra nodal site of lymphoma. Colonic lymphoma is less common than lymphoma involving the stomach or small bowel. In fact, lymphoma represents less than 1% of all colonic neoplasms, although it is found with increased frequency in patients with AIDS, Crohn’s disease, and ulcerative colitis. It is also more common in men than in women and typically occurs in patients between the ages of 50 and 70 years. Of all primary gastrointestinal lymphomas, 50–60% are non-Hodgkin's lymphoma [9, 10]. Over 50% of all cases of non-Hodgkin's lymphoma demonstrate gastrointestinal lymphoma and gastrointestinal involvement at autopsy, and up to 10% of cases of high-grade, earlystage non-Hodgkin's lymphoma involve the gastrointestinal tract [11]. The annual occurrence rate approximates 1.5 cases per 100,000 adults [10, 12, 13]. The propensity for the gastrointestinal tract to be involved with lymphoma is based on the abundance of lymphatic tissue present throughout much of the bowel. In addition to the wellrecognized submucosal lymphatic deposits in Peyer patches, there are large amounts of mucosa-associated lymphoid tissue present in the gut, especially in the stomach. These lymphoid aggregations are covered with a specialized intestinal epithelium and have an important function for the immune system. Ingested antigens are exposed to these specialized lymphoid complexes and are transported to macrophages and helper lymphocytes deeper within the gut wall. Antigens are processed, interleukins and T lymphocytes proliferate, and B cells are stimula
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