식도의 원발성 NK-/T- 세포 림프종 1예
Primary NK-/T- Cell Lymphoma of the Esophagus: a Case Presentation and Literature Review
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림프절외 NK/T 세포 림프종은 비호지킨 림프종의 아형으로 비강이나 부비동에서 흔히 관찰되며 위장관에서 원발성으로 나타나는 경우는 극히 드물다. 진단이 되더라도 병의 경과가 진행되어 예후가 좋지 않다. 본 증례는 명치통증의 보편적인 증상을 통해 내시경검사를 시행하여 하부 식도에서 불규칙한 표면에 변연이 약간 융기되고 경계가 예리하게 잘 지어진 종축 양상의 식도 궤양형 병변이 발견되었다. 반복적인 내시경과 조직검사 및 endoscopic mucosal resection with a cap-fitted panendoscopy를 통해 조기 진단을 내리고, 치료를 통해 완전 관해를 이룬 원발성 식도 NK/T 세포 림프종 1예를 경험하였기에 문헌 고찰과 함께 보고한다.
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) is an uncommon neoplasm, and it is a subtype of non-Hodgkin’s lymphoma. It most commonly presents in the nasal cavity and nasopharynx. But only 10% of ENKL may present on the skin or the gastrointestinal tract and this has a poor prognosis. We report here on a case of CD56＋ NK/T-cell lymphoma that limited to the esophagus. A 55-year-old male patient presented with epigastric soreness. Esophagogastroduodenoscopy (EGD) showed well demarcated, longitudinal ulcerative lesions with an irregular base and a discrete margin on the lower esophagus. We performed EGDs and endoscopic biopsies 2 times, but these were insufficient to make a diagnosis. The 3rd time, we finally took a big piece of tissue using endoscopic mucosal resection with a cap-fitted panendoscope (EMR-C). The biopsies showed surface ulceration and a heavy lymphoid infiltration and a positive pattern for CD3, CD56 and granzyme B. The pathologic diagnosis was NK/T-cell lymphoma. The patient was treated with concurrent chemoradiation followed by additional chemotherapy and he achieved a complete response.
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