ABSTRACT
Infection by the Human T- Lymphotropic virus I (HTLV-1) causes Adult T cell Leukemia-lymphoma (ATLL), being the duodenal involvement rare. Commonly, patients co-infected with HTLV-1 and Strongyloides stercoralis are seen due to the lack of TH2 response found on these patients. We describe a 48-year- old woman, from the jungle of Peru, with a family history of HTLV-1 infection, who presented with a History of chronic diarrhea and weight loss. HTLV-1 infection with ATLL and strongyloidiasis were diagnosed. Ivermectin treatment and chemotherapy were initiated, being stabilized, and discharged. We report this case because of the unusual coexistence in the duodenum of ATLL and strongyloidiasis.
Subject(s)
Coinfection/diagnosis , Duodenal Neoplasms/diagnosis , HTLV-I Infections/diagnosis , Leukemia-Lymphoma, Adult T-Cell/diagnosis , Strongyloides stercoralis/isolation & purification , Strongyloidiasis/diagnosis , Animals , Duodenal Neoplasms/parasitology , Duodenal Neoplasms/virology , Female , Humans , Middle AgedABSTRACT
La infección por el virus linfotrópico de células T humanas tipo 1 (HTLV-1), es causante de la leucemia/linfoma de células T del Adulto (ATLL), siendo la afectación duodenal poco usual. La coinfección de HTLV-1 con Strongyloides stercolaris es común en los pacientes con HTLV- 1 debido a la inadecuada respuesta TH2 que presentan estos sujetos. Describimos a una paciente mujer de 48 años de edad, natural y procedente de la selva del Perú con historia familiar de infección por HTLV- 1 quien acude con diarrea crónica y baja de peso. Se le diagnosticó infección por HTLV-1 así como ATLL duodenal y estrongiloidiasis. Se inició tratamiento con ivermectina y quimioterapia, siendo estabilizada y dada de alta. Reportamos el presente caso debido a la poca frecuencia de coexistencia en duodeno de ATLL y estrongiloidiasis.
Infection by the Human T- Lymphotropic virus I (HTLV-1) causes Adult T cell Leukemia-lymphoma (ATLL), being the duodenal involvement rare. Commonly, patients co-infected with HTLV-1 and Strongyloides stercoralis are seen due to the lack of TH2 response found on these patients. We describe a 48-year-old woman, from the jungle of Peru, with a family history of HTLV-1 infection, who presented with a History of chronic diarrhea and weight loss. HTLV-1 infection with ATLL and strongyloidiasis were diagnosed. Ivermectin treatment and chemotherapy were initiated, being stabilized, and discharged. We report this case because of the unusual coexistence in the duodenum of ATLL and strongyloidiasis.
Subject(s)
Animals , Female , Humans , Middle Aged , Strongyloidiasis/diagnosis , HTLV-I Infections/diagnosis , Leukemia-Lymphoma, Adult T-Cell/diagnosis , Strongyloides stercoralis/isolation & purification , Duodenal Neoplasms/diagnosis , Coinfection/diagnosis , Duodenal Neoplasms/parasitology , Duodenal Neoplasms/virologySubject(s)
Anemia/etiology , Duodenal Neoplasms/etiology , Herpesviridae Infections/etiology , Herpesvirus 8, Human/isolation & purification , Kidney Transplantation/adverse effects , Sarcoma, Kaposi/etiology , Tumor Virus Infections/etiology , Aged , Anemia/diagnosis , Antineoplastic Agents/therapeutic use , Antiviral Agents/therapeutic use , Biopsy , Disease Progression , Drug Substitution , Duodenal Neoplasms/diagnosis , Duodenal Neoplasms/drug therapy , Duodenal Neoplasms/immunology , Duodenal Neoplasms/virology , Female , Gastroscopy , Herpesviridae Infections/diagnosis , Herpesviridae Infections/drug therapy , Herpesviridae Infections/immunology , Herpesviridae Infections/virology , Herpesvirus 8, Human/immunology , Humans , Immunocompromised Host , Immunohistochemistry , Immunosuppressive Agents/adverse effects , Sarcoma, Kaposi/diagnosis , Sarcoma, Kaposi/drug therapy , Sarcoma, Kaposi/immunology , Sarcoma, Kaposi/virology , Tomography, X-Ray Computed , Tumor Virus Infections/diagnosis , Tumor Virus Infections/drug therapy , Tumor Virus Infections/immunology , Tumor Virus Infections/virologyABSTRACT
Non-Hodgkin's lymphoma of B-cell type is the second most common neoplasm after Kaposi's sarcoma, among patients with human immunodeficiency virus infection. Most non-Hodgkin's lymphoma cases that are associated with acquired immunodeficiency syndrome involve extranodal sites, especially the digestive tract and the central nervous system. We report a case of primary lymphoma of the duodenum in a patient with AIDS. Upper gastrointestinal endoscopy revealed pseudopolypoid masses found in the second portion of the duodenum. A complete diagnostic study including histological, immunohistochemical and virological analyses showed high-grade B-cell Burkitt's lymphoma. The Epstein-Barr virus genome was detected in biopsies by immunohistochemical and in situ hybridization.
Subject(s)
Burkitt Lymphoma/diagnosis , Duodenal Neoplasms/diagnosis , Lymphoma, AIDS-Related/diagnosis , Duodenal Neoplasms/virology , Fatal Outcome , Genome, Viral , Herpesvirus 4, Human/genetics , Humans , In Situ Hybridization , Lymphoma, AIDS-Related/virology , Male , Middle AgedABSTRACT
Non-Hodgkin's lymphoma of B-cell type is the second most common neoplasm after Kaposi's sarcoma, among patients with human immunodeficiency virus infection. Most non-Hodgkin's lymphoma cases that are associated with acquired immunodeficiency syndrome involve extranodal sites, especially the digestive tract and the central nervous system. We report a case of primary lymphoma of the duodenum in a patient with AIDS. Upper gastrointestinal endoscopy revealed pseudopolypoid masses found in the second portion of the duodenum. A complete diagnostic study including histological, immunohistochemical and virological analyses showed high-grade B-cell Burkitt's lymphoma. The Epstein-Barr virus genome was detected in biopsies by immunohistochemical and in situ hybridization.
O linfoma não-Hodgkin de células B é a segunda neoplasia mais comum em pacientes com infecção pelo vírus da imunodeficiência humana depois do sarcoma de Kaposi. A maioria dos casos de linfoma não-Hodgkin associados com a síndrome da imunodeficiência adquirida envolve locais extraganglionares, especialmente o trato digestivo e o sistema nervoso central. Nós relatamos um caso de linfoma primário do duodeno em um paciente com AIDS. Uma endoscopia digestiva alta mostrou massas pseudopolipóides encontradas na segunda porção do duodeno. Um estudo diagnóstico completo incluindo exames histológicos, imunohistoquímicos e virológicos mostrou um linfoma de células B tipo Burkitt. Detectou-se genoma do vírus Epstein-Barr em biópsias por hibridização in situ e imuno-histoquímica.
Subject(s)
Humans , Male , Middle Aged , Burkitt Lymphoma/diagnosis , Duodenal Neoplasms/diagnosis , Lymphoma, AIDS-Related/diagnosis , Duodenal Neoplasms/virology , Fatal Outcome , Genome, Viral , /genetics , In Situ Hybridization , Lymphoma, AIDS-Related/virologyABSTRACT
A 52-year-old Tunisian patient had fever, impaired health and several opportunistic infections (Campylobacter jejuni, Mycobacterium hominis, Herpes virus, Giardia intestinalis, Vibrio metschnikovii). Lymphocytopenia was noted (348/mm3; CD4+: 2.2%; CD4+/CD8+: 0.1). Polymerase chain rection search for HIV was negative in serum and in tumor tissue. Diagnosis of primary digestive Kaposi sarcoma was established at autopsy due to the deep location of the lesions. There was an ulcerofungating tumor spreading over 1.3 m of the duodenojejunum. This is the fourth reported case of CD4+ lymphocytopenia, a new and very rare immunodeficiency syndrome recently defined by the Centers for Disease Control. We detected human herpes virus 8 by immunohistochemistry of tumor tissue. Human herpes virus 8 is implicated in the pathogenesis of Kaposi sarcoma.
Subject(s)
CD4-Positive T-Lymphocytes , Duodenal Neoplasms/pathology , Duodenal Neoplasms/virology , HIV Seronegativity , Herpesviridae Infections/complications , Herpesvirus 8, Human , Jejunal Neoplasms/pathology , Jejunal Neoplasms/virology , Lymphopenia/complications , Opportunistic Infections/complications , Anorexia/virology , Autopsy , Biopsy , CD4 Lymphocyte Count , Diarrhea/virology , Duodenal Neoplasms/complications , Duodenal Neoplasms/immunology , Fatal Outcome , Female , Fever/virology , Herpesviridae Infections/diagnosis , Herpesviridae Infections/virology , Humans , Immunohistochemistry , Jejunal Neoplasms/complications , Jejunal Neoplasms/immunology , Lymphopenia/blood , Lymphopenia/diagnosis , Middle Aged , Opportunistic Infections/microbiology , Polymerase Chain ReactionABSTRACT
We describe the clinicopathologic, immunophenotypic, and molecular findings in 4 cases of anaplastic large cell lymphoma (ALCL) arising in the small intestine. All patients were men with acute symptoms of gastrointestinal tract obstruction. The clinical preoperative diagnosis was gastrointestinal carcinoma in 3 cases, and pancreatic carcinoma in 1 case. Histologic examination revealed cohesive aggregates of neoplastic cells, with multiple vesicular nuclei, prominent nucleoli, and abundant amphophilic cytoplasm. There was no clinical or histopathologic evidence of enteropathy. All cases were CD30+, and all showed evidence of T-cell lineage with cytotoxic potential by expression of CD3, CD43, or CD45RO; T-cell intracellular antigen-1; or perforin. One tumor showed p80 and anaplastic lymphoma kinase (ALK) overexpression corroborated by the presence of the t(2:5). One tumor expressed Epstein-Barr virus latent membrane protein. In all cases, the tumor cells were negative for CD20, CD15, CD56, and cytokeratin. Polymerase chain reaction revealed clonal rearrangements of the T-cell receptor gamma-chain gene, without evidence of immunoglobulin heavy-chain gene rearrangement. The diagnosis of primary bowel ALCL is facilitated by immunophenotypic and molecular studies. With 24 months of clinical follow-up, only the patient with the t(2:5)-positive tumor is alive and free of disease, suggesting that p80/ALK overexpression may be a good prognostic indicator.