Brahmania Mayur, Sylwesterowic Thomas, Leitch Heather
Department of Medicine, Division of Gastroenterology & Hematology, St Paul's Hospital, Vancouver, BC, V5Z 1M9, Canada.
J Med Case Rep. 2011 May 3;5:168. doi: 10.1186/1752-1947-5-168.
Plasmablastic lymphoma is an aggressive non-Hodgkin lymphoma classically occurring in individuals infected with HIV. Plasmablastic lymphoma has a predilection for the oral cavity and jaw. However, recent case reports have shown lymphoma in the stomach, lung, nasal cavity, cervical lymph nodes and jejunum in HIV-negative individuals. We report what is, to the best of our knowledge, the first case of plasmablastic lymphoma occurring in the ano-rectal junction of an HIV-negative man.
A previously healthy 59-year-old Caucasian man presented with painless rectal bleeding. Colonoscopy revealed a lesion in the ano-rectal junction, with pathological examination demonstrating atypical lymphoid cells consisting primarily of plasmablasts with rounded nuclei, coarse chromatin, small nucleoli and multiple mitotic figures. Immunohistochemical analysis showed the atypical cells were negative for CD45, CD20, CD79a and immunoglobulin light chains, but were strongly positive for CD138 and EBV-encoded RNA. The results were consistent with a diagnosis of plasmablastic lymphoma. Aggressive systemic chemotherapy and involved field radiation therapy resulted in complete clinical and pathological remission.
Increasing awareness of plasmablastic lymphoma in HIV-negative individuals and in this location is warranted.
浆母细胞性淋巴瘤是一种侵袭性非霍奇金淋巴瘤，典型地发生于感染人类免疫缺陷病毒（HIV）的个体。浆母细胞性淋巴瘤好发于口腔和颌部。然而，最近的病例报告显示，HIV阴性个体的胃、肺、鼻腔、颈部淋巴结和空肠也会出现淋巴瘤。据我们所知，我们报告了首例发生于HIV阴性男性肛门直肠交界处的浆母细胞性淋巴瘤病例。
一名59岁的既往健康的白种男性因无痛性直肠出血就诊。结肠镜检查发现肛门直肠交界处有一处病变，病理检查显示非典型淋巴细胞，主要由核圆形、染色质粗糙、核仁小且有多个有丝分裂象的浆母细胞组成。免疫组化分析显示，非典型细胞CD45、CD20、CD79a和免疫球蛋白轻链均为阴性，但CD138和EB病毒编码的RNA呈强阳性。结果符合浆母细胞性淋巴瘤的诊断。积极的全身化疗和累及野放射治疗导致临床和病理完全缓解。
有必要提高对HIV阴性个体及该部位浆母细胞性淋巴瘤的认识。
