乙状结肠是胃肠道原发性恶性淋巴瘤起源的罕见部位。此外,免疫抑制剂,广泛用于治疗自身免疫性疾病,与恶性肿瘤的诱发有关,包括淋巴增生性疾病.在这份报告中,我们介绍了一个罕见的胃肠道穿孔病例,提示免疫抑制治疗之间的联系,特别是他克莫司治疗,和弥漫性大B细胞淋巴瘤(DLBCL)。一名75岁的女性患者在我们的急诊室出现腹痛。她有多发性肌炎和间质性肺炎的病史,用免疫抑制剂他克莫司治疗.腹部CT扫描显示腹腔内有游离气体,导致胃肠道穿孔的诊断。患者表现为全身性腹膜炎,并在同一天接受了急诊手术。手术期间,发现乙状结肠穿孔,进行了Hartmann手术.术后病理显示CD20+,CD30+,CD5-,CD10-,BCL6+,MUM1+,和50-60%的MIB-1LI。确诊为DLBCL,分类为EBV阳性弥漫性大B细胞淋巴瘤,未指定(NOS),在乙状结肠,有了积极的EBER-ISH,LMP-1和EBNA2结果。鉴于她使用免疫抑制剂的历史,她被归类为患有其他医源性免疫缺陷相关淋巴增生性疾病(OIIA-LPD),根据2017年WHO分类。该病例强调了临床医生考虑与长期使用免疫抑制剂相关的肿瘤发生风险的重要性。
The sigmoid colon is an uncommon site for the origin of primary malignant lymphomas in the GI tract. Additionally, immunosuppressive agents, widely used in treating autoimmune diseases, have been associated with the induction of malignancies, including lymphoproliferative disorders. In this report, we present a rare case of GI perforation suggesting a link between immunosuppressive therapy, particularly tacrolimus treatment, and diffuse large B-cell lymphoma (DLBCL). A 75-year-old female patient presented with abdominal pain to our ER. She had a medical history of polymyositis and interstitial pneumonia, treated with the immunosuppressant tacrolimus. An abdominal CT scan revealed free gas in the abdominal cavity, leading to a diagnosis of GI perforation. The patient exhibited generalized peritonitis and underwent emergency surgery the same day. During surgery, a perforation in the sigmoid colon was identified, and a Hartmann procedure was performed. Postoperative pathology showed CD20+, CD30+, CD5-, CD10-, BCL6+, MUM1+, and MIB-1 LI of 50-60%. The diagnosis of DLBCL was confirmed, classified as EBV-positive diffuse large B-cell lymphoma, not otherwise specified (NOS), in the sigmoid colon, with positive EBER-ISH, LMP-1, and EBNA2 findings. Given her history of immunosuppressant use, she was categorized as having other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD), according to the WHO Classification of 2017. This case highlights the importance for clinicians to consider the risk of oncogenesis associated with the prolonged use of immunosuppressive agents.