Assuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por HIV/complicações , Neoplasias do Íleo/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Tumor de Músculo Liso/diagnóstico , Adulto , Infecções por Vírus Epstein-Barr/cirurgia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Herpesvirus Humano 4/isolamento & purificação , Humanos , Neoplasias do Íleo/cirurgia , Neoplasias do Íleo/virologia , Íleo/diagnóstico por imagem , Íleo/patologia , Linfoma Difuso de Grandes Células B/cirurgia , Linfoma Difuso de Grandes Células B/virologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Primárias Múltiplas/virologia , Tumor de Músculo Liso/cirurgia , Tumor de Músculo Liso/virologia , Tomografia Computadorizada por Raios XRESUMO
Posttransplant lymphoproliferative disorder is a relatively common posttransplant malignancy affecting as many as 10% of all solid-organ recipients. Most cases of posttransplant lymphoproliferative disorder are of B-cell origin, with common Epstein-Barr virus association. Posttransplant lymphoproliferative disorders of T-cell origin are much rarer and less frequently associated with Epstein-Barr virus. Here, we report an unusual case of Epstein-Barr virus-positive anaplastic large-cell lymphoma causing an intestinal perforation in an adult renal transplant recipient. A 52-year-old male patient with renal allograft developed cryptogenic end-stage liver failure and was accepted as a candidate for liver transplant. Before transplant, he was admitted with severe abdominal pain, which turned out to result from ileal perforation. Pathologic evaluation of the intestinal resection showed diffuse malignant lymphoid infiltration of the ileum, consistent with anaplastic large-cell lymphoma. The tumor was positive for Epstein-Barr virus genome. Anaplastic large-cell lymphoma is a rare form of T-cell posttransplant lymphoproliferative disorder that is infrequently associated with Epstein-Barr virus. The occurrence of this extraordinary form of post transplant lymphoproliferative disorder, its late onset, intestinal localization, and Epstein-Barr virus as sociation represent a unique clinical rarity.
Assuntos
Infecções por Vírus Epstein-Barr/virologia , Herpesvirus Humano 4/isolamento & purificação , Neoplasias do Íleo/virologia , Transplante de Rim/efeitos adversos , Linfoma Anaplásico de Células Grandes/virologia , Dor Abdominal/virologia , Biópsia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Evolução Fatal , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico , Imuno-Histoquímica , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/virologia , Linfoma Anaplásico de Células Grandes/complicações , Linfoma Anaplásico de Células Grandes/diagnóstico , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening hyperinflammatory syndrome characterized by activated macrophages engulfing erythrocytes, leukocytes, platelets, and their precursor cells in bone marrow, liver, spleen, or lymph nodes. We report a case of Epstein-Barr virus (EBV)-associated HLH unusually presenting as an ileal mass. A 23-year-old man presented initially with persistent fever unresponsive to antibiotics and pancytopenia. A bone marrow aspiration and biopsy were used to diagnose the patient with aplastic anemia and HLH. A relatively well-defined low-density mass was radiologically noted in the terminal ileum, along with enlarged lymph nodes, and was suspected to be malignant lymphoma or an abscess. The ileocecectomy specimen revealed a transmural hemorrhagic infarction with numerous activated macrophages phagocytosing erythrocytes, plasma cells, and lymphocytes, and he was diagnosed with EBV-associated HLH. The patient received an allo-unrelated peripheral blood stem-cell transplantation and expired due to graft-versus-host disease following liver failure. The present case is very unique, in that EBV-associated HLH presented with an unusual ileal mass resulting from hemorrhagic infarction in a patient with aplastic anemia, suggesting variability in the biological behavior of EBV-associated disease.
Assuntos
Anemia Aplástica/complicações , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4/crescimento & desenvolvimento , Neoplasias do Íleo/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Anemia Aplástica/patologia , Anemia Aplástica/virologia , Infecções por Vírus Epstein-Barr/patologia , Infecções por Vírus Epstein-Barr/cirurgia , Infecções por Vírus Epstein-Barr/virologia , Evolução Fatal , Histocitoquímica , Humanos , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Neoplasias do Íleo/virologia , Linfo-Histiocitose Hemofagocítica/patologia , Linfo-Histiocitose Hemofagocítica/cirurgia , Linfo-Histiocitose Hemofagocítica/virologia , Masculino , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Adenocarcinoma/virologia , Doença de Crohn/virologia , Infecções por Citomegalovirus/patologia , Neoplasias do Íleo/virologia , Adenocarcinoma/patologia , Doença de Crohn/patologia , Citomegalovirus/isolamento & purificação , Feminino , Humanos , Neoplasias do Íleo/patologia , Pessoa de Meia-IdadeRESUMO
EBV-positive diffuse large B-cell lymphoma (DLBCL) in elderly is a new entity included provisionally in the most recent WHO Classification of lymphoid neoplasms. It usually affects elderly patients and has a poor survival. The goal of this report was to evaluate clinical, endoscopic characteristics and survival of five patients with this entity and gastrointestinal afectation. From five cases, three cases had gastric infiltration, one ileon and one in cecum.
Assuntos
Infecções por Vírus Epstein-Barr/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Ceco/diagnóstico , Neoplasias do Ceco/mortalidade , Neoplasias do Ceco/virologia , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/mortalidade , Neoplasias do Íleo/virologia , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/virologiaRESUMO
El Linfoma de Células Grandes B difuso del anciano asociado al Epstein Barr es una nueva entidad incluida provisionalmente en la más reciente clasificación de neoplasias linfoides de la WHO. Usualmente afecta ancianos y tiene pobre sobrevida. El objetivo de este reporte fue evaluar las característica clínicas, endoscópicas y sobrevida de cinco pacientes portadores de esta entidad y compromiso gastrointestinal. Tres casos tuvieron infiltración gástrica y dos casos tuvieron compromiso del ileón y el ciego.
EBV-positive diffuse large B-cell lymphoma (DLBCL) in elderly is a new entity included provisionally in the most recent WHO Classification of lymphoid neoplasms. It usually affects elderly patients and has a poor survival. The goal of this report was to evaluate clinical, endoscopic characteristics and survival of five patients with this entity and gastrointestinal afectation. From five cases, three cases had gastric infiltration, one ileon and one in cecum.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Vírus Epstein-Barr/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Neoplasias do Ceco/diagnóstico , Neoplasias do Ceco/mortalidade , Neoplasias do Ceco/virologia , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/mortalidade , Neoplasias do Íleo/virologia , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/virologia , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/virologiaRESUMO
Enteroviruses commonly infect the gastrointestinal tract, and replication of enteroviruses has been well documented in the Peyer patches of the small bowel. Chronic enterovirus infection has been found in the stomach and terminal ileum of patients with myalgic encephalomyelitis/chronic fatigue syndrome. The authors report the unexpected finding of enterovirus VP1 protein, by immunoperoxidase staining, in carcinoid tumours found in one patient with myalgic encephalomyelitis/chronic fatigue syndrome and another patient with chronic lower quadrant abdominal pain, and suggest a possible association between enteroviruses and tumorigenesis.
Assuntos
Neoplasias do Apêndice/virologia , Tumor Carcinoide/virologia , Infecções por Enterovirus/complicações , Neoplasias do Íleo/virologia , Enterovirus , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Proteínas Estruturais Virais/metabolismoRESUMO
Although no increased risk of developing lymphoproliferative disorders has been observed in population-based studies of patients with Crohn's disease, the possibility has been suggested in the subset of patients previously treated with thiopurine metabolites and suffering from concomitant Epstein-Barr virus infection. A few cases of lymphomas have occurred in patients with Crohn's disease treated with infliximab, only one of whom showed the presence of the Epstein-Barr virus genome. We here describe the case of a patient with steroid-dependent ileal Crohn's disease treated with azathioprine and a single infusion of infliximab, who developed a diffuse large B cell ileal lymphoma. Epstein-Barr virus genome was detected in the neoplastic cells by means of polymerase chain reaction. Epstein-Barr virus may be detected in the neoplastic tissues of lymphomas of patients with Crohn's disease treated with immunosuppressants and infliximab. The identification of such cases may help to define the frequency of this association and how to manage the lymphoproliferative disorder.