Gamma/Delta T-Cell Lymphoma of Duodenal BulbA Case Report

Abstract

Gamma/delta T-cells represent a minor subset of T lymphocytes in the peripheral blood of limited diversity and a tissue restricted distribution. 1 Groh V Porcelli S Fabbi M Lanier LL Picker LJ Anderson T et al. Human lymphocytes bearing T cell receptor gamma/delta are phenotypically diverse and evenly distributed throughout the lymphoid system. J Exp Med. 1989; 169: 1277-1294 Crossref PubMed Scopus (437) Google Scholar , 2 Falini B Flenghi L Pileri S Pelicci P Fagioli M Martelli MF et al. Distribution of T cells bearing different forms of the T cell receptor gamma/delta in normal and pathological human tissues. J Immunol. 1989; 143: 2480-2488 PubMed Google Scholar These T-cells have a predilection for the red pulp of the spleen and the GI tract. 1 Groh V Porcelli S Fabbi M Lanier LL Picker LJ Anderson T et al. Human lymphocytes bearing T cell receptor gamma/delta are phenotypically diverse and evenly distributed throughout the lymphoid system. J Exp Med. 1989; 169: 1277-1294 Crossref PubMed Scopus (437) Google Scholar , 2 Falini B Flenghi L Pileri S Pelicci P Fagioli M Martelli MF et al. Distribution of T cells bearing different forms of the T cell receptor gamma/delta in normal and pathological human tissues. J Immunol. 1989; 143: 2480-2488 PubMed Google Scholar , 3 Bordessoule D Gaulard P Mason DY Preferential localisation of human lymphocytes bearing gamma delta T cell receptors to the red pulp of the spleen. J Clin Pathol. 1990; 43: 461-464 Crossref PubMed Scopus (72) Google Scholar Most neoplasms arising from the gamma/delta T-cell subpopulation are hepatosplenic gamma/delta T-cell lymphomas, a distinctive clinicopathologic entity. 4 Wong KF Chan JK Matutes E McCarthy K Ng CS Chan CH et al. Hepatosplenic gamma delta T-cell lymphoma. A distinctive aggressive lymphoma type. Am J Surg Pathol. 1995; 19: 718-726 Crossref PubMed Scopus (96) Google Scholar , 5 Cooke CB Krenacs L Stetler-Stevenson M Greiner TC Raffeld M Kingma DW et al. Hepatosplenic T-cell lymphoma: a distinct clinicopathologic entity of cytotoxic gamma delta T-cell origin. Blood. 1996; 88: 4265-4274 PubMed Google Scholar Several cases have been reported of non-hepatosplenic gamma/delta T-cell lymphoma in specific sites such as cutaneous tissue, 6 Fujita M Miyachi Y Furukawa F Toichi E Furukawa I Nakajima N Imamura S A case of cutaneous T-cell lymphoma expressing gamma delta T-cell receptors. J Am Acad Dermatol. 1993; 28: 355-360 Abstract Full Text PDF PubMed Scopus (26) Google Scholar , 7 Arnulf B Copie-Bergman C Delfau-Larue MH Lavergne-Slove A Bosq J Wechsler J et al. Nonhepatosplenic gammadelta T-cell lymphoma: a subset of cytotoxic lymphomas with mucosal or skin localization. Blood. 1998; 91: 1723-1731 PubMed Google Scholar the nasopharyngeal region, 7 Arnulf B Copie-Bergman C Delfau-Larue MH Lavergne-Slove A Bosq J Wechsler J et al. Nonhepatosplenic gammadelta T-cell lymphoma: a subset of cytotoxic lymphomas with mucosal or skin localization. Blood. 1998; 91: 1723-1731 PubMed Google Scholar , 8 Kanavaros P Lescs MC Briere J Divine M Galateau F Joab I et al. Nasal T-cell lymphoma: a clinicopathologic entity associated with peculiar phenotype and with Epstein-Barr virus. Blood. 1993; 81: 2688-2695 PubMed Google Scholar the GI tract, 7 Arnulf B Copie-Bergman C Delfau-Larue MH Lavergne-Slove A Bosq J Wechsler J et al. Nonhepatosplenic gammadelta T-cell lymphoma: a subset of cytotoxic lymphomas with mucosal or skin localization. Blood. 1998; 91: 1723-1731 PubMed Google Scholar , 9 Lavergne A Brocheriou I Delfau MH Copie-Bergman C Houdart R Gaulard PH Primary intestinal gamma-delta T-cell lymphoma with evidence of Epstein-Barr virus. Histopathology. 1998; 32: 271-276 Crossref PubMed Scopus (23) Google Scholar , 10 Tsujikawa T Itoh A Bamba M Andoh A Hodohara K Inoue H et al. Aggressive jejunal gamma delta T-cell lymphoma derived from intraepithelial lymphocytes: an autopsy case report. J Gastroenterol. 1998; 33: 280-284 Crossref PubMed Scopus (6) Google Scholar , 11 Katoh A Ohshima K Kanda M Haraoka S Sugihara M Suzumiya J et al. Gastrointestinal T cell lymphoma: predominant cytotoxic phenotypes, including alpha/beta, gamma/delta T cell and natural killer cells. Leuk Lymphoma. 2000; 39: 97-111 Crossref PubMed Scopus (57) Google Scholar and a single case involving the thyroid gland. 12 Yamaguchi M Ohno T Kita K gamma/delta T-cell lymphoma of the thyroid gland. N Engl J Med. 1997; 336: 1391-1392 Crossref PubMed Scopus (38) Google Scholar Reported here is the first case of gamma/delta T-cell lymphoma of the duodenal bulb. Expression of gamma/delta T-cell receptor (TCR) was confirmed by both genetic analysis of the TCR gamma and the delta chain by using the polymerase chain reaction (PCR) method, and immunostaining of TCR gamma. Systemic examination by CT and gallium scintigraphy incidentally revealed metastasis to the right lobe of the thyroid gland. The patient was treated with combination chemotherapy and was disease free at one year follow-up.