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溃疡性结肠炎患者患经典型霍奇金淋巴瘤的罕见病例。

Rare case of classic Hodgkin lymphoma in a patient with ulcerative colitis.

作者信息

Chua Nicole Allyson, Sollano Jose

机构信息

Section of Gastroenterology, Cardinal Santos Medical Center, San Juan City, Philippines

Section of Gastroenterology, Cardinal Santos Medical Center, San Juan City, Philippines.

出版信息

BMJ Case Rep. 2024 Dec 11;17(12):e259507. doi: 10.1136/bcr-2023-259507.

DOI:10.1136/bcr-2023-259507
PMID:39663134
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11647077/
Abstract

Primary gastrointestinal tract lymphoma (PGIL) is a rare form of presentation of gastrointestinal tract (GI) lymphomas. Inflammatory bowel disease (IBD) and the use of thiopurines are known risk factors for its appearance. We report a male patient in his early 70s treated only with mesalamine for ulcerative colitis (UC) for the past 6 years. He was admitted due to COVID-19 and anaemia secondary to massive haematochezia. The patient underwent total colectomy with end ileostomy, with intraoperative proctoscopy. Tissue biopsy demonstrated typical features of UC; however, atypical lymphoid proliferation of the regional lymph nodes with histological and immunochemical staining results was suggestive of classic Hodgkin lymphoma, nodular sclerosis subtype. The patient was treated with adriamycin, vinblastine and dacarbazine chemotherapy initially successful after 1 session but later opted for palliative care. Due to its rarity, lymphoid neoplasms occurring in the context of IBD are poorly known.

摘要

原发性胃肠道淋巴瘤（PGIL）是胃肠道（GI）淋巴瘤的一种罕见表现形式。炎症性肠病（IBD）和硫嘌呤的使用是其出现的已知危险因素。我们报告一名70岁出头的男性患者，在过去6年中仅接受美沙拉嗪治疗溃疡性结肠炎（UC）。他因COVID-19和大量便血继发贫血入院。患者接受了全结肠切除术加末端回肠造口术，并进行了术中直肠镜检查。组织活检显示为UC的典型特征；然而，区域淋巴结的非典型淋巴样增殖，结合组织学和免疫化学染色结果，提示为经典型霍奇金淋巴瘤，结节硬化亚型。患者最初接受阿霉素、长春花碱和达卡巴嗪化疗，1个疗程后最初取得成功，但后来选择了姑息治疗。由于其罕见性，IBD背景下发生的淋巴样肿瘤鲜为人知。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/1980d6691fa7/bcr-17-12-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/61b8ef6f52f4/bcr-17-12-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/bdae315594ee/bcr-17-12-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/0d596fda4274/bcr-17-12-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/b09a9acef627/bcr-17-12-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/f89051e3b824/bcr-17-12-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/fa773f976122/bcr-17-12-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/1980d6691fa7/bcr-17-12-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/61b8ef6f52f4/bcr-17-12-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/bdae315594ee/bcr-17-12-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/0d596fda4274/bcr-17-12-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/b09a9acef627/bcr-17-12-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/f89051e3b824/bcr-17-12-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/fa773f976122/bcr-17-12-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e546/11647077/1980d6691fa7/bcr-17-12-g007.jpg

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本文引用的文献

1
Incidence of lymphomas in inflammatory bowel disease: report of an emblematic case, systematic review, and meta-analysis.炎症性肠病中淋巴瘤的发病率：1例典型病例报告、系统评价及荟萃分析
Front Med (Lausanne). 2023 May 3;10:1172634. doi: 10.3389/fmed.2023.1172634. eCollection 2023.
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Increasing Risk of Lymphoma Over Time in Crohn's Disease but Not in Ulcerative Colitis: A Scandinavian Cohort Study.随着时间的推移，克罗恩病患者发生淋巴瘤的风险增加，但溃疡性结肠炎患者则不然：一项斯堪的纳维亚队列研究。
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Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019.
204 个国家和地区 1990 年至 2019 年炎症性肠病的全球、区域和国家负担：基于 2019 年全球疾病负担研究的系统分析。
BMJ Open. 2023 Mar 28;13(3):e065186. doi: 10.1136/bmjopen-2022-065186.
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[Pathological characteristics and clinical prognosis of nodular sclerosis grade 2 of classic Hodgkin's lymphoma].[经典型霍奇金淋巴瘤2级结节硬化型的病理特征及临床预后]
Zhonghua Zhong Liu Za Zhi. 2022 Jun 23;44(6):581-586. doi: 10.3760/cma.j.cn112152-20210302-00190.
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Rectal Hodgkin lymphoma in a patient with ulcerative colitis: a case study.一名溃疡性结肠炎患者的直肠霍奇金淋巴瘤：病例报告
Diagn Pathol. 2015 Apr 16;10:25. doi: 10.1186/s13000-015-0271-7.
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Risk of lymphoma in patients with inflammatory bowel disease treated with azathioprine and 6-mercaptopurine: a meta-analysis.炎症性肠病患者应用硫唑嘌呤和 6-巯基嘌呤治疗后发生淋巴瘤的风险：一项荟萃分析。
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