Collins Katrina, Toklu Ani, Dave Nishi, Mesa Hector
Department of Pathology Indiana University School of Medicine Indianapolis Indiana USA.
Department of Pathology University of Maryland School of Medicine and Medical Center Baltimore Maryland USA.
JGH Open. 2025 Apr 17;9(4):e70154. doi: 10.1002/jgh3.70154. eCollection 2025 Apr.
Lymphomas present a significant challenge in the field of gastrointestinal diseases, often being mistaken for other gastrointestinal tumors or inflammatory bowel disease conditions, causing clinical confusion. Early diagnosis plays a pivotal role in effective treatment. This case highlights the importance of recognizing lymphoproliferative disorders as a rare association of anti-tumor necrosis factor-α (TNF-α) therapy.
A 41-year-old man with a 15-year history of Crohn disease on long-term therapy with adalimumab underwent a right hemicolectomy due to a semi-circumferential lesion at the ileocecal valve causing near complete obstruction and severe anemia (Hgb 6.4 g/dL). Previous biopsies of the mass showed an Epstein Barr Virus-positive (EBV+) classic Hodgkin lymphoma (CHL) in Crohn disease. At resection, the lymphoma showed transmural involvement of the ileum and regional lymph nodes.
Primary intestinal CHL comprises less than 5% of gastrointestinal lymphomas; CHL arising in the context of Crohn disease is even more rare. Most lymphomas associated with inflammatory bowel disease and/or immunosuppression are non-Hodgkin type. In this case, the long-term treatment with anti-TNF-α and EBV positivity suggested an iatrogenic immunodeficiency-associated lymphoma, an emerging group of lymphoproliferative disorders associated with the increased use of immunosuppressants.
淋巴瘤在胃肠疾病领域构成重大挑战，常被误诊为其他胃肠肿瘤或炎症性肠病，导致临床诊断混乱。早期诊断对有效治疗起关键作用。本病例强调了将淋巴增殖性疾病识别为抗肿瘤坏死因子-α（TNF-α）治疗罕见关联的重要性。
一名41岁男性，有15年克罗恩病病史，长期接受阿达木单抗治疗，因回盲瓣处半环形病变导致近乎完全梗阻和严重贫血（血红蛋白6.4g/dL）接受了右半结肠切除术。此前肿块活检显示克罗恩病中存在爱泼斯坦-巴尔病毒阳性（EBV+）经典霍奇金淋巴瘤（CHL）。切除时，淋巴瘤显示累及回肠全层及区域淋巴结。
原发性肠道CHL占胃肠淋巴瘤的比例不到5%；克罗恩病背景下发生的CHL更为罕见。大多数与炎症性肠病和/或免疫抑制相关的淋巴瘤为非霍奇金类型。在本病例中，长期抗TNF-α治疗及EBV阳性提示为医源性免疫缺陷相关淋巴瘤，这是一组与免疫抑制剂使用增加相关的新兴淋巴增殖性疾病。
