Published online Jul 21, 2020. doi: 10.3748/wjg.v26.i27.3989
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
Processing time: 112 Days and 7.8 Hours
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.
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.
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.
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.