J Korean Med Sci.  2010 Mar;25(3):496-500. 10.3346/jkms.2010.25.3.496.

A Case Report with Plasmablastic Lymphoma of the Jejunum

• Cha JM
• Lee JI
• Joo KR
• Jung SW
• Shin HP
• Lee JJ
• Kim GY

• KMID: 1778052
• DOI: http://doi.org/10.3346/jkms.2010.25.3.496

Abstract

Plasmablastic lymphoma (PBL) is a recently identified entity that is considered to be a type of diffuse large B-cell lymphoma with a unique immunophenotype and a predilection for the oral cavity of patients with the human immunodeficiency virus (HIV). Although its clinical features may help in the differential diagnosis, an extraoral location in a patient without HIV makes it more difficult to suspect clinically. This case report is the first to describe a patient with PBL originating from the jejunum in a 60-yr-old, HIV-seronegative man. Computed tomography of the face, chest and abdomen showed about a 9.4x9.0 cm mass of the proximal jejunum, multiple masses in the musculoskeletal soft tissue, and multiple lymphadenopathies. The histological examinations demonstrated a large cell lymphoma with plasmablastic differentiation. The neoplastic cells were diffusely positive for MUM1, epithelial membrane antigen and lambda light chains, and focally positive for CD79a; but negative for CD3, CD20, CD30, CD34, CD45RO, CD56, CD99, and CD117. The proliferation index by Ki-67 immunohistochemistry was approximately 70%. These findings were compatible with the diagnosis of PBL. The findings in this case suggest that PBL should be included in the differential diagnosis of a small bowel mass even in a HIV-negative patient.

Keyword

HIV-negative; Jejunum; Plasmablastic Lymphoma

MeSH Terms

Diagnosis, Differential
Humans
Immunophenotyping
Jejunal Neoplasms/immunology/*pathology/therapy
Jejunum/immunology/*pathology
Lymphoma, Large-Cell, Immunoblastic/immunology/*pathology/therapy
Male
Middle Aged

Figure

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  Fig. 1 Endoscopic finding. The conventional esophagogastroduodenoscopy showed a friable ulcerofungating mass over 10 cm segment.

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  Fig. 2 Radiologic images of a jejunal mass. (A) Abdominal CT shows a 9.4×9.0 cm enhancing lobulated mass (arrow) originating from the proximal jejunum. (B) Small bowel series shows a growing exophytic mass (arrows) with central ulcers in the proximal jejunum. The adjacent bowel loops were displaced; however, the other small bowel loops were normal. A B

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  Fig. 3 CT imaging showing multiple areas of lymphoma infiltration. Arrows indicate lymphoma lesions. (A) About a 2.3 cm ovoid mass in the right submandibular space. (B, C) Multiple oval or round masses in the musculoskeletal soft tissue in the chest wall and pectoralis major muscle. (D) Chest CT shows a right supraclavicular lymphadenopathy.

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  Fig. 4 Histopathology of plasmablastic lymphoma. (A) Haematoxylin and eosin section reveals a diffuse plasmablastic infiltrate with abundant cytoplasm, round nuclei, and occasionally central locating nucleoli (H&E stain, ×400). (B) The lymphoid infiltrate was positive for MUM1 (Polymer method, ×200). (C) Lambda light chain reactivity is seen in virtually all tumor cells (Polymer method, ×400). (D) The stain for Ki-67 demonstrates nuclear staining in approximately 70% of the neoplastic cells (Polymer method, ×400).

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