Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2023; 15(1): 195-204
Published online Jan 15, 2023. doi: 10.4251/wjgo.v15.i1.195
Intestinal natural killer/T-cell lymphoma presenting as a pancreatic head space-occupying lesion: A case report
Ya-Nan Wang, Yi-Miao Zhu, Xiao-Ju Lei, Yuan Chen, Wan-Mao Ni, Zheng-Wei Fu, Wen-Sheng Pan
Ya-Nan Wang, Zheng-Wei Fu, College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310032, Zhejiang Province, China
Ya-Nan Wang, Yi-Miao Zhu, Wen-Sheng Pan, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Xiao-Ju Lei, Department of Endoscopy Center, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Yuan Chen, Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Wan-Mao Ni, Cancer Center, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Wan-Mao Ni, Molecular Diagnosis Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Author contributions: Wang YN, Zhu YM, Lei XJ and Chen Y assembled, analyzed, and interpreted the patient’s data and case presentation; Wang YN, Zhu YM, Ni WM and Fu ZW prepared the original manuscript; Pan WS edited and critically revised the manuscript; all authors contributed to writing the manuscript, read and approved the final manuscript.
Supported by the Major Science and Technology Project of Zhejiang Provincial Department of Science and Technology, No. 2020C03030; and the Foundation of Zhejiang Educational Committee, No. Y202146136.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Sheng Pan, MD, Doctor, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou 310014, Zhejiang Province, China. wspan223@163.com
Received: October 20, 2022
Peer-review started: October 20, 2022
First decision: November 15, 2022
Revised: December 11, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 15, 2023
Processing time: 81 Days and 21.5 Hours
Abstract
BACKGROUND

Intestinal natural killer/T-cell lymphoma (NKTCL) is a rare and aggressive non-Hodgkin’s lymphoma, and its occurrence is closely related to Epstein-Barr virus infection. In addition, the clinical symptoms of NKTCL are not obvious, and the specific pathogenesis is still uncertain. While NKTCL may occur in any segment of the intestinal tract, its distinct location in the periampullary region, which leads clinicians to consider mimics of a pancreatic head mass, should also be addressed. Therefore, there remain huge challenges in the diagnosis and treatment of intestinal NKTCL.

CASE SUMMARY

In this case, we introduce a male who presented to the clinic with edema of both lower limbs, accompanied by diarrhea, and abdominal pain. Endoscopic ultrasound (EUS) showed well-defined homogeneous hypoechoic lesions with abundant blood flow signals and compression signs in the head of the pancreas. Under the guidance of EUS- fine needle biopsy (FNB) with 19 gauge or 22 gauge needles, combined with multicolor flow cytometry immunophenotyping (MFCI) helped us diagnose NKTCL. During treatments, the patient was prescribed the steroid (dexamethasone), methotrexate, ifosfamide, L-asparaginase, and etoposide chemotherapy regimen. Unfortunately, he died of leukopenia and severe septic shock in a local hospital.

CONCLUSION

Clinicians should enhance their understanding of NKTCL. Some key factors, including EUS characteristics, the right choice of FNB needle, and combination with MFCI, are crucial for improving the diagnostic rate and reducing the misdiagnosis rate.

Keywords: Intestinal natural killer/T-cell lymphoma; Endoscopic ultrasound-guided fine-needle biopsy; Multicolor flow cytometry immunophenotyping; Diagnosis; Case report

Core Tip: Intestinal natural killer/T-cell lymphoma (NKTCL) is a rare form of lymphoma with a low diagnosis rate. The patient presented in this case was eventually diagnosed with intestinal NKTCL. The patient initially improved after receiving chemotherapy with the steroid (dexamethasone), methotrexate, ifosfamide, L-asparaginase, and etoposide regimen but died two days after being discharged from the hospital. This case tells us that endoscopic ultrasound may be very helpful in the diagnosis of NKTCL. A 19 gauge or 22 gauge fine needle biopsy needle combined with multicolor flow cytometry immunophenotyping may be a good choice for diagnosing and subtyping lymphoma.