Abstract
Involvement of the anus by a malignant lymphoma is rare, but occurs with a high incidence in acquired immunodeficiency syndrome patients, with most cases having a B-cell phenotype. Although NK/T cell lymphomas; the nasal type, often present with skin or gastrointestinal tract involvement, there has been no reported cases of anal involvement in Korea. Herein, we describe the case of a 23-year-old man who presented with fever, weight loss and a perianal abscess. A biopsy specimen of the anus revealed an extranodal NK/T cell lymphoma of the nasal type. In-situ hybridization for the Epstein-Barr Virus proved positive. Despite the use of combination chemotherapy, the patient died due to the disease 2 months after diagnosis. In patients presenting with a perianal lesion, other involved sites, as well as B symptoms, lymphoma involvement of the anus should be considered, with a biopsy of the anus performed.
REFERENCES
1). Ioachim HL, Antonescu C, Giancotti F, Dorsett B, Weinstein MA. EBV-associated anorectal lymphomas in patients with acquired immune deficiency syndrome. Am J Surg Pathol. 1997; 21:997–1006.
2). Hill VA, Hall-Smith P, Smith NP. Cutaneous T-cell lymphoma presenting with atypical perianal lesions. Dermatology. 1995; 190:313–6.
3). Hernandez JA, Ribera JM, Marti S, Vaquero M. Ki-1 (CD30) positive Large cell anaplastic lymphoma located in the anus in a female patient with human immunodeficiency virus infection. Med Clin (Barc). 1997; 109:645–6.
4). Dashkovsky I, Cozacov JC. Unusual presentation of angiocentric T-cell lymphoma mimicking perianal abscess. J Cutan Med Surg. 2003; 7:247–9.
5). Shneider B, Touloukian R, Hajjar F, Selsky C, Buckley P. Perianal ulceration. A novel manifestation of angiocentric lymphoma. Dig Dis Sci. 1993; 38:1162–6.
6). Ko YH, Kim CW, Park CS, et al. REAL classification of malignant lymphomas in the Republic of Korea: incidence of recently recognized entities and changes in clinicopathologic features. Hematolymphoreticular Study Group of the Korean Society of Pathologists. Revised European-American lymphoma. Cancer. 1998; 83:806–12.
7). Kang YK, Kim BS, Kim TW, et al. Clinicopathologic characteristics of Korean non-hodgkin's lymphomas based on REAL classification. Cancer Res Treat. 1999; 31:641–52.
8). Klas JV, Rothenberger DA, Wong WD, Madoff RD. Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes. Cancer. 1999; 85:1686–93.
9). Freudenberg S, Palma P, Grobholz R, Ngendahayo L, Post S. HIV-related and Epstein-Barr virus-associated anal Burkitt's lymphoma: report of a case. Dis Colon Rectum. 2005; 48:1656–9.
10). Ko YH, Cho EY, Kim JE, et al. NK and NK-like T-cell lymphoma in extranasal sites: a comparative clinicopathological study according to site and EBV status. Histopathology. 2004; 44:480–9.
11). Chan JK, Sin VC, Wong KF, et al. Nonnasal lymphoma expressing the natural killer cell marker CD56: a clinicopathologic study of 49 cases of an uncommon aggressive neoplasm. Blood. 1997; 89:4501–13.
12). Kim CW. Classification of non-hodgkin lymphoma. Korean J Hematol. 1996; 31:3–11.
13). Jaffe ES, Harris NL, Stein H, Vardiman JW. World Health Organization Classification of Tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press;2006. p. 204–7.