Natural Killer-Like T-Cell Lymphoma Localized to the Terminal Ileum: Case Report.

Intestinal intraepithelial lymphocytes are non-organized lymphoid populations that are composed of heterogeneous subsets with diverse ontogeny and phenotypes, and the differential diagnosis is crucial. A 43-year-old male patient underwent an emergency laparotomy due to a perforated mass of the terminal ileum. A right hemicolectomy plus small bowel resection was performed. Histopathological examination showed medium to large cells with vesicular nuclei, including marked nucleoli with large, colorless cytoplasm. No signs of celiac disease were found in the adjacent mucosa. The tumor cells were immunohistochemically CD45+, CD3+, CD4+, CD8+, CD56+, Pan-Cytokeratin-, CD20-, CD79a-, CD5- and CD30-. Endomysial antibody and antigliadin antibody, IgM and IgG tests; and anti-Ebstein Barr virus latent membrane protein all proved negative. Finally, the histopathological diagnosis of tumor mass was natural killer-like T-cell lymphoma. Primary intestinal cytotoxic natural killer-like T-cell lymphoma is a rare entity, which is difficult to distinguish from other T-cell lymphomas. In addition to microscopic evaluation, immunohistochemical analysis and serological tests are essential to reach a definitive diagnosis.

Primary spinal epidural Hodgkin's lymphoma.

Primary spinal epidural Hodgkin's lymphoma is very rare. We will discuss the clinical features and treatment of primary spinal epidural Hodgkin's lymphoma. In this paper, a 30-year-old male patient who presented with spinal epidural tumor at the T9-11 level is reported. Subtotal resection of the tumor was performed and the histological examination of the tumor specimen revealed Hodgkin's lymphoma. All other examinations were negative for an occult disease. Six courses of chemotheraphy containing adriamycin, bleomycin, vinblastine and dacarbazine were given to the patient. Surgery is the first therapeutic approach in malignancies compressing the spinal cord. Hodgkin's lymphoma is a very chemo- and radio-sensitive tumor. The indications for surgery were reduced and limited to laminectomy or even biopsy only, leaving the major role to chemo- and radiotheraphy.

Perivascular epithelioid cell tumor of the ileum presenting as diverticulitis.

Perivascular epithelioid cell tumors (PEComas) are a group of rare mesenchymal neoplasms. Gastrointestinal PEComas are exceptionally rare, there being only a few case reports in the literature involving the colon and small intestine. Nearly all PEComas show immunoreactivity for both melanocytic (HMB45 and/or Melan-A) and smooth muscle (actin and/or desmin) markers. A 36-year-old male was admitted to the hospital with acut- abdomen. At laparatomy, a nodular mass protruding from the ileum which clinically simulated a diverticulitis was noticed. Gross examination of the specimen revealed a 2 × 1,5 × 1 cm secondarily ulcerated, solid, nodular, gray white tumor mass in the ileal wall. Histologically, tumor cells were composed of nests of round-polygonal epithelioid cells with abundant clear to slightly eosinophilic granular cytoplasm and round vesicular nuclei. The nests were separated by thin fibrovascular septa. Minimal necrosis and low mitotic activity were noticed in the tumor. Immunohistochemically, tumor cells were positive for SMA, HMB45, and Melan-A and negative for CD10, RCC, CD45, CD117, CD34, EMA, and Desmin. Diagnosis was PEComa of the ileum. We report the case of ileal PEComa to remind the unusual presentation (diverticulitis) of these tumors, besides rarity and diagnostic difficulties.

Endometriosis of the terminal ileum: a diagnostic dilemma.

Endometriosis is characterized by the presence of endometrial tissue consisting of glands and/or stroma located outside the uterus. Involvement of the terminal ileum is extremely rare. Preoperative distinction of ileal endometriosis from other diseases of the ileocecal region is difficult in terms of clinical presentation, symptomatology, radiological appearance, and surgical and pathological findings. We report a case initially diagnosed as Crohn's disease due to a longstanding diarrhea with subsequent intestinal obstruction, but finally diagnosed as ileal endometriosis by histopathological evaluation after resection of the involved segment.

Ureteritis cystica presenting with atrophic kidney: report of a case.

Ureteritis cystica is a rare proliferative condition that is found predominantly in the bladder, renal pelvis, and upper ureter. It may occlude the ureteral lumen and should be considered in the reasons for an atrophic kidney. A 65-year-old-female with a 2-year history of right flank pain that increased in the last 2 months was presented. Abdominal ultrasonography revealed right-sided atrophic kidney. Nephroureterectomy was performed. On the gross examination, along the ureter wall, there were numerous polyps, 0.5 cm in maximum diameter, protruding into the lumen. On the histopathological evaluation, ureteritis cystica and chronic pyelonephritis was detected. In conclusion, ureteritis cystica is a benign and indolent lesion that needs to be kept in mind among the causes of renal atrophy.