Song JH, Choi JE, Kim JS. Mucocutaneous ulcer positive for Epstein–Barr virus, misdiagnosed as a small bowel adenocarcinoma: A case report. World J Gastrointest Surg 2023; 15(10): 2362-2366 [PMID: 37969717 DOI: 10.4240/wjgs.v15.i10.2362]
Corresponding Author of This Article
Jin Soo Kim, MD, PhD, Assistant Professor, Department of Surgery, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, Sejong 30099, South Korea. jskim7562@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2362-2366 Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2362
Mucocutaneous ulcer positive for Epstein–Barr virus, misdiagnosed as a small bowel adenocarcinoma: A case report
Ji Hyeong Song, Ji Eun Choi, Jin Soo Kim
Ji Hyeong Song, Jin Soo Kim, Department of Surgery, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
Ji Eun Choi, Department of Pathology, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
Author contributions: Song JH contributed to formal analysis, investigation, and writing the original draft; Choi JE contributed to writing review, editing, and data curation; Kim JS contributed to conceptualization, methodology, project administration, supervision, validation, and visualization; and all authors have read and approved the final manuscript.
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 the authors report no relevant conflicts of interest for this article.
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: Jin Soo Kim, MD, PhD, Assistant Professor, Department of Surgery, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, Sejong 30099, South Korea. jskim7562@gmail.com
Received: July 4, 2023 Peer-review started: July 4, 2023 First decision: August 4, 2023 Revised: August 18, 2023 Accepted: August 31, 2023 Article in press: August 31, 2023 Published online: October 27, 2023 Processing time: 114 Days and 22.3 Hours
Abstract
BACKGROUND
Epstein–Barr virus (EBV)-positive mucocutaneous ulcers (MCUs) are an uncommon disorder characterized by ulcerative lesions in the skin, oral cavity or gastrointestinal tract in patients with iatrogenic or aging-induced immunosuppression. The nonspecific lesions are difficult to differentiate from small bowel adenocarcinomas. We present the case of a 69-year-old woman who was initially misdiagnosed with a small bowel adenocarcinoma but was later surgically diagnosed with and treated for EBV-MCU. Through this case, we aim to emphasize the importance of accurately distinguishing between the two conditions.
CASE SUMMARY
The patient presented with an incidental finding of a small bowel tumor during computed tomography (CT) examination performed for hematuria. The CT scan showed irregular thickening of the distal ileum, which was suggestive of a malignant small bowel tumor. An exploratory laparotomy revealed an 8-cm mass in the distal ileum; thus, a segment of the small intestine, including the mass, was resected. Histopathological analysis revealed an ulceroinfiltrative mass-like lesion with luminal narrowing, marked inflammatory cell infiltration, and large atypical lymphoid cells (positive for EBV-encoded small RNA). A final diagnosis of an EBV-MCU was established. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. The patient remained recurrence-free until 12 mo after surgery.
CONCLUSION
This case highlights the diagnostic challenges for EBV-MCUs and emphasizes the importance of comprehensive evaluation and accurate histopathological analysis.
Core Tip: We report a case that highlights the diagnostic challenges of distinguishing an Epstein–Barr virus-mucocutaneous ulcer from a small bowel adenocarcinoma in a 69-year-old woman. It emphasizes the importance of performing comprehensive evaluation and accurate histopathological analysis to guide appropriate management. Awareness of this rare entity is crucial for its timely diagnosis and prevention of unnecessary invasive procedures.
