Lymphoma in autopsy cases

Unsuspected systemic Epstein-Barr virus-positive T-cell lymphoma of childhood diagnosed at autopsy in a potential homicide case

Systemic Epstein-Barr virus (EBV)-positive T-cell lymphoma of childhood (SETLC) is a rare, rapidly progressive, and often fatal disease of children and young adults characterized by monoclonal expansion of EBV-positive T cells in tissues or peripheral blood following infection with EBV. Its distinction from other EBV-positive T-cell lymphoproliferative disorders with overlapping features can be difficult, and particular diagnostic features may not be manifest until autopsy examination. We present the case of a 10-year-old boy with significant disability due to remote traumatic brain injury following non-accidental head trauma who died unexpectedly at home. Given the history of physical abuse and the potential for homicide charges, significant medicolegal implications arose with this case. Pathologic investigation ultimately revealed conclusive diagnostic features of SETLC including extensive proliferation of EBV-positive T cells in multiple organs. A natural manner of death was confirmed, thereby excluding delayed homicide related to complications of non-accidental head trauma.

Peripheral T-cell Lymphoma With Acute Exacerbating Fatigue and Chest Pain: A Case Report

Effectively treating vague symptoms in older adults can be challenging for clinicians. Many vague symptoms will resolve spontaneously with alleviating treatment. Two of the most alarming qualities of symptoms are duration and exacerbation. For primary care and family medicine physicians dealing with vague symptoms in older patients, identifying alarming symptoms and further investigating them can guide their decisions on advanced care directives. We experienced a case of a drastic clinical course of peripheral T-cell lymphoma in a 91-year-old man without specific symptoms or palpable lymphadenopathy on the surface of the body. Clinical observation and prompt pathological investigation were sufficient for diagnosis. However, the patient’s hope for home-based palliative care could not be achieved. For vague progressive symptoms in older patients, clinicians should consider the diagnostic process, including perspectives of palliative care, based on the needs of older patients.

Natural Killer T Cell Intravascular Lymphoma With Presentation of Musculoskeletal Pain: A Case Report

Natural killer T cell intravascular lymphoma is a rare category of lymphoma among older individuals. The presentation of natural killer T cell lymphoma varies, causing diagnostic challenges for clinicians. Thus far, only a few studies have reported this condition in the context of musculoskeletal symptoms. We encountered a case of natural killer T cell intravascular lymphoma in a patient who presented with symptoms of sternoclavicular arthritis and femoral pain. The initial diagnosis was undifferentiated hematologic malignancy because undifferentiated hematologic malignant cells were seen on the bone marrow biopsy. Further examination showed that the patient had a high fever and abnormal cells in the blood. Flow cytometry findings revealed the abnormal cells as CD16 and CD56 positive, leading to the diagnosis of natural killer T cell intravascular lymphoma. This is the first report indicating the possibility of natural killer T cell intravascular lymphoma as one of the differential diagnoses of acute joint and muscular pains among older patients and the importance of assessing multiple organs, including musculoskeletal organs, to diagnose intravascular lymphoma.

T-cell lymphoproliferative processes in the spleen

T-cell lymphoproliferative processes in the spleen are rare and it is important to study normal T cell subsets in the spleen to understand the splenic milieu in which they arise. True malignant T-cell processes including hepatosplenic T-cell lymphoma and T-cell large granular lymphocytic leukemia occur in the spleen, but other atypical reactive T-cell proliferations and those of uncertain significance also have been described. Proper distinction of florid T cell responses from malignant T-cell neoplasms has important therapeutic implications for the patient.