Korean J Gastroenterol.  2011 Jun;57(6):365-369. 10.4166/kjg.2011.57.6.365.

A Case of Natural Killer Like T Cell Lymphoma Misdiagnosed as Behcet's Enteritis of the Terminal Ileum

• Joo YW
• Koh DH
• Lee KN
• Lee HL
• Jun DW
• Yoon BC
• Choi HS
• Lee OY

• KMID: 1792801
• DOI: http://doi.org/10.4166/kjg.2011.57.6.365

Abstract

Primary natural killer (NK) cell like T cell lymphoma of the terminal ileum is extremely rare. It most frequently occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. NK/T cell lymphoma involving gastrointestinal tract has characteristic endoscopic features of Inflammatory bowel disease. We herein describe a first case of primary NK/T cell lymphoma misdiagnosed as Behcet's enteritis of the terminal ileum colonoscopically and complicated by cecal bleeding and perforation.

Keyword

Natural killer like T cells lymphoma; Behcet's disease; Inflammatory bowel disease

Figure

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  Fig. 1. Barium enema showing a single deep penetrating ulcer (arrows) in the terminal ileum. Converging fold and mucosal thickening were seen around the ulcer.

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  Fig. 2. Endoscopic photographs of the natural killer cell like T cell lymphoma of the terminal ileum. (A) Single deep penetrating ulcers mimicking Behcet's ileitis in the terminal ileum at initial presentation.(B) Somewhat healing changes at the second colonoscopic examination after short term (2 weeks) steroid treatment. (C) Extensive infilatrating ulcerative mass lesion mimicking Crohn's disease with a marginal oozing was observed on 6-month follow-up colonoscopy. (D) Still remained ulcerative mass lesion after short term antituberculosis medication.

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  Fig. 3. (A) Gross appearance of the resected terminal ileum, showing hemorrhage and perforation. (B) Medium to large size atypical lymphocyte infiltration was seen, and high mitotic index (72/10 HPF) was noted (H&E, ×400). (C) Angiocentric growth pattern of medium to large lymphoid cells (H&E, ×100). (D) Immunochemical staining of the tumor cells, showing strong reactivity to both CD3 and CD56 monoclonal antibody (H&E, ×100).

Reference

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