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Li S, Fang X, Liu Y, Yue Q, Yu J. Pulmonary extranodal natural killer/T-cell lymphoma: clinical presentation, CT characteristics, and patient outcomes. Quant Imaging Med Surg 2023; 13:8358-8369. [PMID: 38106312 PMCID: PMC10722052 DOI: 10.21037/qims-23-365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Background Due to the extreme rarity of pulmonary extranodal natural killer/T-cell lymphoma (ENKTCL), studies on this lymphoma type are limited. We aimed to investigate the clinical presentations, computed tomography (CT) findings, CT dynamic changes, and outcomes of patients diagnosed with pulmonary ENKTCL. Methods We conducted a retrospective cohort study on ENKTCL, nasal type, at West China Hospital, from January 2010 to January 2023. Out of 27 initial cases with pulmonary ENKTCL, we excluded 4 due to the lack of chest CT images, resulting in a final cohort of 23 patients. Our evaluation covered clinical features, laboratory findings, CT presentations, treatment strategies, and survival outcomes. Survival analyses were performed using the Kaplan-Meier method, with log-rank tests for survival curve comparisons. Given the small sample size, our interpretation of the data is mainly descriptive. Results The most common CT presentations in our institution was solitary or multiple nodules (7/23, 30.4%). The halo sign (78.3%) and floating vessels sign (83.3%) were commonly observed in pulmonary ENKTCL. Elevated lactate dehydrogenase (LDH) levels were observed in 20 (86.9%) patients. The median overall survival (OS) for pulmonary ENKTCL patients was 1 month; 3 cases displayed a favorable prognosis, maintaining complete remission (CR) status for 1.5-7 years after receiving chemotherapy. Chemotherapy led to improved prognosis, with a median survival of 5 months seen in patients who received chemotherapy. Patients with bilateral lung involvement had worse outcomes compared to those with unilateral lesions. Conclusions Pulmonary ENKTCL is a rare and aggressive disease, often misdiagnosed due to nonspecific clinical and CT features. Laboratory tests, failure of antibiotic treatment, and "floating vessels sign" on enhanced CT scans may aid in diagnosis. Timely chemotherapy may improve survival, emphasizing the importance of early detection and prompt treatment.
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Affiliation(s)
- Shuang Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Fang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Yue
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Akbar M, Clasen-Linde E, Specht L. Extranodal NK/T-cell lymphoma, nasal type, with extranasal presentation - a case report and a review of the literature. Acta Oncol 2020; 59:1480-1487. [PMID: 32689856 DOI: 10.1080/0284186x.2020.1795250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Extranodal NK/T-cell lymphoma (ENKTCL), nasal type is a very rare and aggressive non-Hodgkin lymphoma. Most commonly it occurs in the upper aerodigestive tract. But, it can also manifest at locations such as the skin, soft tissue, gastrointestinal tract (GI), lungs, testis, etc. These locations are designated as extranasal ENKTCL. The patients with the latter have often more adverse clinical features and poorer survival rate compared with nasal sites. We present a case of an 83-year-old patient with a primary ENKTCL, nasal type, with extranasal presentation in the right upper eyelid. MATERIAL AND METHODS Materials for the literature review was obtained by a comprehensive search on PubMed, which yielded 82 eligible cases with extranasal ENKTCL. RESULTS Sixty-eight cases (83 %) were localized as primary ENKTCL in the lungs (17), central nervous system (CNS) (14), testis (11), GI-tract (7), skin (6), orbit and intraocular tissue (4), pancreas (2), adrenal gland (2), breast (1), etc. 14 cases (17 %) presented as extended or disseminated diseases involving exclusively organs outside the upper aerodigestive tract. There was no systematic pattern of organ involvement in the extended/disseminated ENKTCL. 63 % of the patient with localized extranasal ENKTCL and about 50% of patients with extended/disseminated disease were reported to have died of the disease. Treatment strategies varied with no preferred option. Among the used treatment options were chemotherapy, radiotherapy, surgery, stem cell transplantation alone or in different combinations. CONCLUSION ENKTCL is a highly aggressive disease which may present in extranasal areas. Although the tumors respond to both chemotherapy and radiotherapy, durable complete remissions are very rare.
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Affiliation(s)
- Momena Akbar
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
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KANTARCIOĞLU COŞKUN S, ÖZTÜRK NAZLIOĞLU H, BÜYÜKUYSAL MÇ. Clinicopathological Features of Extranodal Lymphomas. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.789919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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4
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Hu Q, Xu L, Zhang X, Wang J, Zhou Z. Primary pulmonary extranodal natural killer/T-cell lymphoma (ENKTL), nasal type: Two case reports and literature review. Medicine (Baltimore) 2020; 99:e20822. [PMID: 32590768 PMCID: PMC7328944 DOI: 10.1097/md.0000000000020822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Extranodal natural killer/T-cell lymphoma (ENKTL) - nasal type is an aggressive form of malignant non-Hodgkin lymphoma with a very poor prognosis. Especially primary pulmonary ENKTL is a relatively rare form of non-Hodgkin lymphoma. Until now, the prevalence of primary pulmonary ENKTL is unknown. Since 2001, only 18 cases of primary pulmonary ENKTL have been published, in addition to the 2 cases reported here. PATIENT CONCERNS We describe 2 cases of primary pulmonary ENKTL. Both patients were male non-smokers, aged 61 and 49 years. Their main clinical symptoms included cold-like symptoms and intermittent fever (39.3°C and 38.8°C) for some days (40 days and 3 weeks). Both patients had no relevant personal or family medical history. DIAGNOSIS The patients were initially misdiagnosed with community-acquired pneumonia. Primary pulmonary ENKTL was confirmed by immunohistochemical staining of computed tomography-guided transthoracic needle biopsy specimens. Both cases were positive for CD56, CD3, and in situ hybridization for Epstein-Barr virus-encoded small RNA, but negative for CD20. INTERVENTIONS Initially, both patients were treated inadequately with intravenous moxifloxacin administration (unknown dosage and 400 mg q.d) in their local hospitals. Once diagnosed with primary pulmonary ENKTL in our hospital, they received 3 cycles of chemotherapy with combined regimens of dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE), and in the second patient, bone marrow transplantation was performed following the third chemotherapy cycle. OUTCOMES Clinical follow-up after the chemotherapy showed that the condition of the first patient progressively deteriorated. He died 2 months following the initial diagnosis. However, the presence of the hemophagocytic lymphohistocytosis gradually improved in the second patient during chemotherapy. Ultimately, the second patient died of acute transplant rejection 6 months after the initial diagnosis. CONCLUSION The diagnosis of ENKTL should be considered when patients present with fever and expansile consolidation of the lung not responding to antibiotics. The diagnosis depends on histopathology and immunophenotyping. Percutaneous transthoracic needle biopsy is a safe and effective biopsy method. Chemotherapy may improve the prognosis, but this should be confirmed by prospective multicenter studies.
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Affiliation(s)
- Qun Hu
- Department of Respiratory, Critical Care and Sleep Medicine, Xiang’an Hospital, Xiamen University, Xiamen
| | - Liyu Xu
- Department of Pulmonary and Critical Care Medicine, Fuzhou First Hospital, Fujian Medical University, Fuzhou
| | - Xiaoming Zhang
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital
| | - Jie Wang
- College of Pharmacy, Shenzhen University, Shenzhen, China
| | - Zizi Zhou
- Department of Cardio-Thoracic Surgery, Shenzhen University General Hospital
- Department of Plastic and Reconstructive Surgery, BG Unfallklinik Ludwigshafen, University of Heidelberg, Heidelberg, Germany
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5
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Qiu YJ, Zhang MZ. [Clinical analyses of 24 patients with primary pulmonary NK/T-cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:40-46. [PMID: 32023753 PMCID: PMC7357901 DOI: 10.3760/cma.j.issn.0253-2727.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical characteristics, the best treatment and prognostic factors of primary pulmonary NK/T-cell lymphoma. Methods: A total of 24 cases with primary pulmonary NK/T-cell lymphoma from April 2011 to May 2019 were analyzed retrospectively. Survival analysis was performed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariate analysis using Cox proportional hazard regression model was conducted to confirm independent prognostic factors for overall survival (OS) and progression-free survival (PFS) . Results: ①The cohort of 24 patients included 16 male and 8 female with a median age of 49 years (range, 4-76 years) old. ②Most patients initially presented with a fever (66.7%) , cough and dyspnea. Chest imaging manifestations were primarily unilateral (45.8%) or bilateral (54.2%) pulmonary consolidation, nodules or mass. ③20 patients received chemotherapy, radiotherapy or hematopoietic stem cell transplantation, the rest 4 cases palliative treatment. Median OS was 9.5 months (range, 0.1-26.0 months) . The estimated 1-year OS rate was 45.8%. Overall response rate of patients treated with asparaginase-based regimen was 88.2%. ④In univariate survival analysis, age≤60 was prognostic for longer OS and PFS, compared with age>60 (P=0.002 and 0.004, respectively) ; ECOG≤2 was prognostic for longer OS and PFS, compared with ECOG>2 (P=0.042 and 0.004, respectively) . In multivariate survival analysis, age>60 and ECOG>2 were significantly correlated with inferior OS and PFS (OS: P=0.024 and 0.024, respectively; PFS: P=0.035 and 0.024, respectively) . Conclusions: Primary pulmonary NK/T-cell lymphoma was a rare disease with poor prognosis. Asparaginase-based regimens appeared to be effective. Age and ECOG served as independent prognostic factors for primary pulmonary NK/T-cell lymphoma patients.
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Affiliation(s)
- Y J Qiu
- Department of Respiratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - M Z Zhang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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6
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Primary pulmonary extranodal NK/T cell lymphoma of an elderly adult: a case report and literature review. J Hematop 2019. [DOI: 10.1007/s12308-019-00380-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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7
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Yabushita T, Yoshioka S, Furumiya T, Nakamura M, Yamashita D, Imai Y, Ishikawa T. The impact of early diagnosis on the prognosis of extranodal NK/T-cell lymphoma with massive lung involvement: a case report. BMC Pulm Med 2019; 19:48. [PMID: 30791900 PMCID: PMC6385406 DOI: 10.1186/s12890-019-0815-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background Pulmonary non-Hodgkin lymphoma (NHL) is rare. The most frequent subtype of pulmonary NHL is low-grade B-cell lymphoma, such as lymphoma of mucosa-associated lymphoma tissue. Extranodal natural killer cell/T-cell lymphoma, nasal type (ENKL) is characterized by predominant extranodal involvement and association with Epstein-Barr virus (EBV). ENKL with massive lung involvement has been infrequently reported, and its prognosis is extremely poor. Case presentation A 20-year-old Japanese man presented with intermittent fever lasting for 2 months. Radiological imaging demonstrated multiple nodules of uneven shape and size in both lungs. Video-assisted thoracic surgical lung biopsy showed abnormal lymphocyte infiltration, which was positive for CD3, CD56, and perforin. In situ hybridization for EBV-encoded RNA was positive. From these findings, he was diagnosed with ENKL with lung involvement. The patient was successfully treated with intensive combinational chemotherapy followed by allogeneic cord blood transplantation. He has been alive with continuous complete remission for 1 year after diagnosis. Conclusions Although ENKL involving the lung has been reported to have dismal outcomes, our patient showed long-term survival after intensive chemotherapy and up-front allogeneic hematopoietic transplantation. The present case highlights the importance of early diagnosis as well as allogeneic transplantation.
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Affiliation(s)
- Tomohiro Yabushita
- Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Takeru Furumiya
- Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Momoko Nakamura
- Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Daisuke Yamashita
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Multiple Cavitary Lung Lesions in an Adolescent: Case Report of a Rare Presentation of Nodular Lymphocyte Predominant Hodgkin Lymphoma. J Pediatr Hematol Oncol 2018; 40:e454-e457. [PMID: 30102646 DOI: 10.1097/mph.0000000000001260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 14-year-old male patient presented with a nonproductive cough, weight loss, fatigue, and malaise. A chest radiograph showed large bilateral cavitary lung lesions in both upper and lower lobes that failed to improve with antibiotics and anti-inflammatory medications. Infectious and rheumatologic work-ups were negative. Thoracoscopic lung biopsies were diagnostic for nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). The patient received combination chemotherapy and immunotherapy based on current treatment standards with an excellent clinical response. NLPHL is a rare B-cell lymphoma that typically presents as peripheral lymph nodal disease, clinically distinct from classical Hodgkin lymphoma. The prognosis of NLPHL in children is favorable, although relapse rates are high. This case details several unique features of NLPHL and describes the presentation, diagnosis, and treatment of an adolescent male with a rare pulmonary and cervical NLPHL, the first such case described in a pediatric patient.
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9
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Qiu Y, Hou J, Hao D, Zhang D. Primary pulmonary NK/T-cell lymphoma: A case report and literature review. Mol Clin Oncol 2018; 8:753-756. [PMID: 29844905 DOI: 10.3892/mco.2018.1613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/18/2018] [Indexed: 11/05/2022] Open
Abstract
Extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is an aggressive disease with poor prognosis. The lung is a relatively rare site of involvement. The current study presents a case of primary pulmonary ENKTL with fever and dyspnea, mimicking pneumonia and initially treated with empirical antibiotics. The patient demonstrated rapid deterioration and died shortly following diagnosis. To the best of our knowledge, large-scale investigations referring to primary pulmonary ENKTL are not available. As a result, the exact incidence and clinical features of primary pulmonary ENKTL are unknown. In the current report, a literature review is presented to discuss the clinical characteristics, diagnosis, treatment, and prognosis factors of this malignant disease.
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Affiliation(s)
- Yajuan Qiu
- Department of Respiration, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Junna Hou
- Department of Respiration, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Dexun Hao
- Department of Respiration, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Dandan Zhang
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Abstract
Pulmonary lymphoproliferative neoplasms are rare lung tumors and account for <1% of all lung tumors. Among them, primary pulmonary lymphomas (PPL) constitute the majority, which include Non-Hodgkin's lymphoma (NHL) that comprise of mucosa-associated lymphoid tissue lymphoma, diffuse large B-cell lymphomas and other rare types of NHL and lymphomatoid granulomatosis. HL, which arises secondary to contiguous spread from the mediastinum, is the rarest type of PPL. Other entities described within the umbrella of pulmonary lymphoproliferative neoplasms include pleural lymphomas and posttransplant lymphoproliferative disorders (PTLD) - which occurs in the poststem cell and organ transplant patients. These neoplasms although rare, have a favorable prognosis, which does not depend on disease resectability. Moreover, with its nonspecific presentation, diagnosis is challenging, which often leads to delayed diagnosis or misdiagnosis in many cases. Therefore, knowledge of this entity is important for the practicing pulmonologist. This review article aims to describe the clinical presentation, diagnosis and management of primarily the entities within PPL, as well as pleural lymphomas and PTLD.
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Affiliation(s)
- Victoria K Tang
- Department of Internal Medicine, Divisions of Critical Care, Pulmonary and Sleep Medicine, UT Health- McGovern Medical School, Houston, Texas, USA
| | - Praveen Vijhani
- Department of Internal Medicine, Divisions of Critical Care, Pulmonary and Sleep Medicine, UT Health- McGovern Medical School, Houston, Texas, USA
| | - Sujith V Cherian
- Department of Internal Medicine, Divisions of Critical Care, Pulmonary and Sleep Medicine, UT Health- McGovern Medical School, Houston, Texas, USA
| | - Manju Ambelil
- Department of Pathology and Laboratory Medicine, UT Health- McGovern Medical School, Houston, Texas, USA
| | - Rosa M Estrada–Y-Martin
- Department of Internal Medicine, Divisions of Critical Care, Pulmonary and Sleep Medicine, UT Health- McGovern Medical School, Houston, Texas, USA
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Mori H, Ebisawa K, Nishimura M, Kanazawa K. Late diagnosis: a case of rapidly progressive extranodal NK/T cell lymphoma, nasal type. BMJ Case Rep 2018; 2018:bcr-2017-221019. [PMID: 29455176 PMCID: PMC5836627 DOI: 10.1136/bcr-2017-221019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Extranodal natural killer (NK)/T cell lymphoma, nasal type is a condition that has poor prognosis. Accurate diagnosis of lymphoma is made by pathological findings. We report a case of extranodal NK/T cell lymphoma, nasal type affecting the lung and liver and which was difficult to diagnose because of negative biopsy results from multiple sites. A 39-year-old man who had dry cough and fever for 1 month was referred to our hospital. He had pancytopenia and elevated serum levels of lactate dehydrogenase and soluble interleukin-2 receptor. Hepatosplenomegaly and multiple lung nodules were found on imaging study. Specimens of bronchoscopic lung, percutaneous liver, bone marrow and random skin biopsies were all negative. Open lung biopsy was not definitive. Unfortunately, disease progression was rapid and fatal before results of pleural fluid cytology and a second liver biopsy showed extranodal NK/T cell lymphoma, nasal type. This report focused on diagnostic planning for rapidly progressive extranodal NK/T-cell lymphoma, nasal type.
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Affiliation(s)
- Hiroyuki Mori
- Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Kei Ebisawa
- Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | | | - Kenji Kanazawa
- General Internal Medicine, Kakogawa Chuo Shimin Hospital, Kakogawa, Hyogo, Japan
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12
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Zhang J, Wang M, Yang X, Liu C, He X. Primary pulmonary extranodal NK/T-cell lymphoma of nasal type misdiagnosed as pneumonia: A case report and literature review. Medicine (Baltimore) 2017; 96:e8914. [PMID: 29245256 PMCID: PMC5728871 DOI: 10.1097/md.0000000000008914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Primary pulmonary NK/T cell lymphoma is extremely rare, and only a few cases have reported so far. Its diagnosis is mainly dependent on open-lung biopsy. PATIENT CONCERNS Here, we report a 44-year-old male who was initially misdiagnosed as having pneumonia according to the clinical characteristics and computed tomography (CT) findings. DIAGNOSIS The first lung biopsy indicated a large number of coagulative necrotic lesions, and definite diagnosis was made after the second lung biopsy following non-response to 6-day wide spectrum antibiotic therapy. The second lung biopsy showed the tumor cells were positive for LCA, CD3ε, CD30, TIA-1, Ki67 and negative for CD20, CD56, CD1a, MPO, CK, S-100, desmin, and CD34. INTERVENTIONS This patient refused to receive further therapy and died 1 month after confirmed diagnosis. OUTCOMES Clinically, it is difficult to differentiate pneumonia from NK/T cell lymphoma in pathology due to the presence of plenty of focal necrosis in primary pulmonary NK/T cell lymphoma. LESSONS The diagnosis of primary pulmonary NK/T cell lymphoma should be based on lung biopsy (usually multiple lung biopsies are required), immunohistochemistry and clinical and imaging findings.
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Affiliation(s)
| | | | | | - Chang Liu
- Mianzhu Hospital of Traditional Chinese Medicine, Sichuan, China
| | - Xin He
- West China Hospital, Sichuan University
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13
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Song M, Kim JY, Choi JS, Yoon B, Kim M, Kim SJ, Kim SY. Primary Pulmonary Extranodal Natural Killer/T-cell Lymphoma, Nasal Type Presenting as Diffuse Ground Glass Opacities: a Case Report. J Korean Med Sci 2017; 32:1727-1730. [PMID: 28875622 PMCID: PMC5592192 DOI: 10.3346/jkms.2017.32.10.1727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/13/2016] [Indexed: 11/20/2022] Open
Abstract
Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTCL) is a rare type of lymphoma that accounts for only 5%-18% of all cases of non-Hodgkin lymphoma (NHL). In published series, 60%-90% of NK/T-cell lymphomas are localized to the nasal and upper airway. We describe a 55-year man who presented with cough, sputum, dyspnea on exertion, and a chest computed tomography scan shows diffuse ground glass opacities (GGOs), suggestive of an interstitial lung disease. He was treated with a corticosteroid and his symptoms improved. However, when the corticosteroid was tapered, his symptoms recurred. The patient underwent a surgical lung biopsy and ENKTCL was diagnosed. We present this case because ENKTCL involving only the lung is very rare but very informative. To our knowledge, our patient is the first case that primary pulmonary ENKTCL is presented with GGOs.
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Affiliation(s)
- MyungJin Song
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Bora Yoon
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - MooHyun Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jeong Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
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14
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Extranodal NK/T Cell Lymphoma Causing Cardiorespiratory Failure. Case Rep Hematol 2016; 2016:2394809. [PMID: 27493813 PMCID: PMC4967471 DOI: 10.1155/2016/2394809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/13/2016] [Accepted: 06/19/2016] [Indexed: 12/02/2022] Open
Abstract
Extranodal NK/T cell lymphoma is an uncommon malignancy usually involving the sinonasal area. We report an unusual case of extranodal NK/T cell lymphoma diagnosed in a 62-year-old Caucasian male who died of progressive cardiorespiratory failure but had no clinically detectable upper respiratory system lesions. The initial diagnosis was made cytologically on a sample of pericardial fluid that contained neoplastic lymphoid cells. These cells were positive for CD2, cytoplasmic CD3, and Epstein-Barr virus and negative for CD56. The diagnosis was confirmed at the autopsy, which disclosed lymphoma infiltrates in the myocardium, lungs, stomach, and pancreas. The death was caused by heart and lung failure due to uncontrollable arrhythmia and respiratory insufficiency due to the lymphoma infiltrates. To the best of our knowledge, this is the first case of extranodal NK/T cell lymphoma presenting with cardiopulmonary failure.
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15
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Yang L, Feng W, Chen C, Zhang X, Zhu Y, Lei W, Huang JA. Primary pulmonary T-cell lymphoma mimicking pneumonia: A case report and literature review. Exp Ther Med 2016; 12:365-368. [PMID: 27347063 DOI: 10.3892/etm.2016.3287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
Primary pulmonary T-cell lymphoma is an extremely rare neoplasm. The present study describes the case of an elderly male patient who was admitted to hospital with initial symptoms including a fever, coughing and dyspnea. A chest computed tomography scan detected pneumonia-like features, including multiple variable nodules, ground-glass opacities, patchy infiltration and subpleural consolidation, which progressed rapidly. No mediastinal or hilar adenopathy was noted. The patient was initially diagnosed with severe pneumonia; however, the patient developed severe respiratory failure and extensive progression in radiographic manifestation despite receiving a combination treatment of broad-spectrum antibiotics and antifungal agents. Negative results were obtained for anti-nuclear antibodies and anti-neutrophil cytoplasmic antibody assays, which eliminated the possibility that the patient was affected by a connective tissue disease. A bronchoscopy with transbronchial lung biopsy was not performed on account of intolerance. A histological examination, which was performed using specimens obtained via video-assisted thoracoscopic surgery, allowed the final diagnosis of T-cell lymphoma to be confirmed. Unfortunately, the patient succumbed to respiratory failure and a probable thoracic hemorrhage prior to the initiation of chemotherapy.
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Affiliation(s)
- Lingyi Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Wei Feng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Cheng Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Xiuqin Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Yehan Zhu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Wei Lei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jian-An Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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16
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A case of primary pulmonary NK/T cell lymphoma presenting as pneumonia. Respir Med Case Rep 2015; 17:1-4. [PMID: 27141431 PMCID: PMC4821249 DOI: 10.1016/j.rmcr.2015.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/14/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
Primary pulmonary lymphoma, particularly non-B cell lymphomas involving lung parenchyma, is very rare. A 46-year-old male was admitted to the hospital with fever and cough. Chest X-ray showed left lower lobe consolidation, which was considered pneumonia. However, because the patient showed no response to empirical antibiotic therapy, bronchoscopic biopsy was performed for proper diagnosis. The biopsied specimen showed infiltrated atypical lymphocytes with angiocentric appearance. On immunohistochemical staining, these atypical cells were positive for CD3, CD30, CD56, MUM-1, and granzyme B, and labeled for Epstein–Barr virus encoded RNA in situ hybridization. These findings were consistent with NK/T cell lymphoma. We report on a case of primary pulmonary NK/T cell lymphoma presenting as pneumonic symptoms and review the literature on the subject.
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17
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Abstract
Primary lung lymphoma (PLL) is a rare disease that comprises <0.5% of all primary lung tumors. It is defined as lymphoma confined to the lung with or without hilar lymph node involvement at the time of diagnosis or up to 3 months thereafter. Patients with PLL may be asymptomatic or manifest nonspecific clinical symptoms, for example, cough, chest pain, and dyspnea. Some individuals may be immunosupressed or have an autoimmune disorder. Radiologically, PLL can mimic pneumonia, lung carcinoma, or metastasis, and therefore, histologic confirmation is mandatory for definitive diagnosis. Primary lung marginal zone lymphoma of mucosa-associated lymphoid tissue type comprises 70% to 80% of cases. Less common B-cell lymphomas include diffuse large B-cell lymphoma, lymphomatoid granulomatosis (LyG), plasmacytoma, and other small lymphocytic lymphomas. PLLs of T-cell origin, largely represented by anaplastic large cell lymphoma, are extremely rare. LyG is an Epstein-Barr virus (EBV)-driven B-cell lymphoid neoplastic proliferation rich in T cells that produces vasculitis. The disease may present at different stages of progression. Differential diagnosis of PLL varies according to the lymphoma subtype: pulmonary mucosa-associated lymphoid tissue lymphoma should be distinguished from reactive inflammatory conditions, whereas high-grade lymphomas may resemble poorly differentiated lung carcinoma, metastatic disease, and other lymphomas. LyG can resemble inflammatory, infectious, and other lymphoid neoplastic processes. A panel of immunohistochemical markers, flow cytometry, and molecular methods are necessary to confirm the diagnosis in the majority of cases. In this article we review the clinical, radiologic, pathologic, and molecular characteristics of several B-cell and T-cell PLLs with exception of Hodgkin lymphoma and posttransplant lymphoproliferative disorder.
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18
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Fei W, Xiaohong W, Hong Z, Bei H. Pulmonary Extranodal Natural Killer/T-Cell Lymphoma (Nasal Type): A Case Report and Radiological Image Review. Medicine (Baltimore) 2015; 94:e1527. [PMID: 26402808 PMCID: PMC4635748 DOI: 10.1097/md.0000000000001527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An 83-year-old woman presented with intermittent fever for 2 weeks. Chest radiography and computed tomography images showed multiple nodules and masses scattered in both lung fields. Tissue samples obtained by computed tomography-guided needle biopsy revealed extranodal natural killer/T-cell lymphoma (ENKL). The lung is the major site of involvement and the skin may be the primary site. The radiological imaging of this case is different from the cases reported before. Besides, we reviewed the medical records of our hospital and searched the Pubmed database and found 12 cases altogether (include the case presented), which were diagnosed with pulmonary ENKL, and the features of chest images were studied. To our knowledge, this is the first time that the chest imaging features of pulmonary ENKL were reviewed. We conclude that if the radiographic manifestations are multiple patchy consolidations or multiple nodules and masses in both lungs with or without bilateral pleural effusions, the diagnostic considerations should include ENKL.
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Affiliation(s)
- Wang Fei
- From the Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Haidian district, Beijing, China
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19
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Chien CC, Lee HS, Lin MH, Hsieh PP. Primary extranodal natural killer/T-cell lymphoma of bronchus and lung: A case report and review of literature. Thorac Cancer 2015; 7:140-4. [PMID: 26816549 PMCID: PMC4718123 DOI: 10.1111/1759-7714.12254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/16/2015] [Indexed: 11/27/2022] Open
Abstract
Primary pulmonary non‐Hodgkin's lymphoma (NHL) is very rare. It represents less than 1% of all NHL, and 0.5–1% of all primary pulmonary malignancies. Almost all cases of primary pulmonary NHL originate from B‐cell lineage. We present a case of a 53‐year‐old man with primary extranodal NK/T‐cell lymphoma of the bronchus and lung, presented progressive dyspnea caused by right lower lung consolidation, and pleural effusion. Initial chest computed tomography suggested advanced lung cancer. Bronchofiberscopy showed a polypoid tumor on which a biopsy was performed. Histologically, the diffusely infiltrative atypical cells were positive for cytoplasmic CD3, CD56, granzyme B, and negative for cytokeratin, CD20 immunostains, suggesting NK/T cell lineages. In situ hybridization for Epstein‐Barr virus encoded ribonucleic acid (EBER) was positive. Herein, we discuss the clinicopathological features of this case and review the literature on primary extranodal NK/T‐cell lymphoma of the lung. Compared with other patients, who died after the first cycle of chemotherapy and/or within three months, our patient had longer survival under aggressive chemotherapy and auto‐peripheral blood stem cell transplantation.
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Affiliation(s)
- Chu-Chun Chien
- Department of Pathology and Laboratory Medicine Veterans General Hospital- Kaohsiung Kaohsiung Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine Veterans General Hospital- Kaohsiung Kaohsiung Taiwan
| | - Min-Hsi Lin
- Department of Internal Medicine, Chest Division Veterans General Hospital- Kaohsiung Kaohsiung Taiwan
| | - Pin-Pen Hsieh
- Department of Pathology and Laboratory Medicine Veterans General Hospital- Kaohsiung Kaohsiung Taiwan
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20
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Gui W, Yang B, Shen Q, Bai M, Wang J, Guan T, Zhao J, Wang J, Su L. Successful treatment with L-asparaginase-based regimen for primary pulmonary NK/T cell lymphoma: a case report and review of the literature. CLINICAL RESPIRATORY JOURNAL 2014; 9:493-6. [PMID: 24761980 DOI: 10.1111/crj.12156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/26/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Wei Gui
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
| | - Bin Yang
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
| | - Quanliang Shen
- Department of Foreign Language; Shanxi Medical University; Shanxi China
| | - Min Bai
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
| | - Jun Wang
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
| | - Tao Guan
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
| | - Jin Zhao
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
| | - Jingrong Wang
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
| | - Liping Su
- Department of Hematology; Shanxi Tumor Hospital; Shanxi China
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21
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Liu CH, Wang HH, Perng CL, Peng CK, Chian CF, Shen CH. Primary extranodal NK/T-cell lymphoma of the lung: Mimicking bronchogenic carcinoma. Thorac Cancer 2014; 5:93-6. [PMID: 26766981 DOI: 10.1111/1759-7714.12021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/10/2012] [Indexed: 11/30/2022] Open
Abstract
Primary extranodal natural killer/T- cell lymphoma, nasal type (NK/TCL) in the lung is extremely rare and associated with Epstein-Barr virus (EBV) infection. An 80-year-old male presented with hemoptysis, which had lasted three days. Physical examination revealed inspiratory crackles at the left lung base and massive splenomegaly. Chest radiograph shows a mass-like lesion in the left lower lung but no active lesion six months earlier. Computed tomography demonstrated a soft tissue mass (size: 6.6 × 5.1 cm) with increased ground-glass opacities in the left lower lobe, several pulmonary nodules, and mediastinal lymphadenopathy. Transthoracic needle biopsy of the left-lower-lobe lung mass was performed. The pathology revealed atypical lymphoid cell infiltration, which is immunoreactive for cytoplasmic CD3, CD30 and CD56, but not reactive for CK and CD20. EBV-encoded RNA (EBER) was also detected in these atypical lymphoid cells. The serum EBV DNA level was 7.03 × 10(6) copies/mL and subtype 1 EBV was identified. No evidence of lymphoma involvement was found in the extrathoracic site. Primary pulmonary lymphoma showing nasal-type NK/T-cell subtype was diagnosed. Chemotherapy with cyclophosphamide and prednisolone was initiated immediately but the patient deteriorated and died three weeks later. In conclusion, patients presenting with rapidly growing lung mass and massive splenomegaly raise the possibility of aggressive pulmonary lymphoma. Extranodal NK/T-cell lymphoma with high baseline plasma EBV DNA levels signifies poor prognosis. Identifying young high-risk patients may have benefits for early aggressive and successful treatment.
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Affiliation(s)
- Chia-Hsin Liu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Hong-Hau Wang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Cherng-Lih Perng
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital Taipei, Taiwan; Graduate Institute of Pathology, National Defense Medical Center Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Chih-Feng Chian
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Chih-Hao Shen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
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22
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Zhang S, Liang B, Jiang S. Primary pulmonary peripheral T-cell lymphoma: A case report and review of the literature. Thorac Cancer 2014; 5:104-7. [PMID: 26766984 DOI: 10.1111/1759-7714.12042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/11/2013] [Indexed: 11/28/2022] Open
Abstract
Primary pulmonary T-cell lymphoma is a rare condition characterized by fever, cough, dyspnea, and bilateral pulmonary nodules, usually diagnosed by transbronchial biopsy or computed tomography (CT) guided needle biopsy and pathology. In view of its poor prognosis, it is critical to distinguish and diagnose this disease as early as possible. We report here a case of a 39-year-old man who presented with fever, cough, expectoration with multiple nodules, and patch shadow in both lungs by chest CT. Tissue samples were taken by CT guided needle biopsy. The histological sample and immunohistochemistry showed peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS). After the patient was treated by chemotherapy for two courses, his condition deteriorated rapidly and he died 2.3 months after the onset of the disease.
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Affiliation(s)
- Song Zhang
- Department of Respiratory, Provincial Hospital affiliated to Shandong University Jinan, China
| | - Bin Liang
- Department of Respiratory, Provincial Hospital affiliated to Shandong University Jinan, China
| | - Shujuan Jiang
- Department of Respiratory, Provincial Hospital affiliated to Shandong University Jinan, China
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23
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Oka H, Ishii H, Komiya K, Kushima H, Yasuda C, Kadota JI. An atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren's syndrome: a case report. BMC Res Notes 2013; 6:367. [PMID: 24025117 PMCID: PMC3847793 DOI: 10.1186/1756-0500-6-367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/10/2013] [Indexed: 11/22/2022] Open
Abstract
Background Sjögren’s syndrome is characterized by lymphocytic infiltration of the exocrine glands, together with polyclonal B-cell activation, and lung diseases are well-known complications of the disease. Therefore, in most cases associated with Sjögren’s syndrome, infiltrating lymphocytes in the lung specimen exhibit the features of B-cells. We herein report an atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome. Case presentation A 46-year-old female was admitted to our hospital because of an abnormal chest roentgenogram finding on a medical checkup. Chest computed tomography showed randomly-distributed micronodules and patchy ground-glass opacities. A surgical biopsied specimen showed an atypical pattern of interstitial pneumonia with numerous lymphoid follicles. Among the infiltrating lymphocytes in the lung, only the monoclonality of the T-cells was proven by a gene rearrangement analysis, but there was no cytological atypicality or genetic disorder revealed by testing the bone marrow aspirate. A diagnosis of Sjögren’s syndrome was made based on the patient’s other symptoms and these negative findings. The patient’s pulmonary lesions have been successfully treated and remission has been maintained for over three years with corticosteroid treatment alone. Conclusion The present patient was an atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome. Although monoclonality of the infiltrating T-cells was proven, the clinical course and the findings of the imaging and laboratory examinations were inconsistent with the previously-reported cases of primary pulmonary T-cell lymphoma. This suggests that the monoclonality of lymphocytes does not always define malignancy. The diagnosis of malignant lymphoma or lymphoproliferative diseases should be made clinically, pathologically and cytogenetically to rule out other similar diseases.
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Affiliation(s)
- Hiroaki Oka
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.
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24
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Gong L, Wei LX, Huang GS, Zhang WD, Wang L, Zhu SJ, Han XJ, Yao L, Lan M, Li YH, Zhang W. Identification of genuine primary pulmonary NK cell lymphoma via clinicopathologic observation and clonality assay. Diagn Pathol 2013; 8:140. [PMID: 23958352 PMCID: PMC3846405 DOI: 10.1186/1746-1596-8-140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Extranodal natural killer (NK)/T-cell lymphoma, nasal type, is an uncommon lymphoma associated with the Epstein-Barr virus (EBV). It most commonly involves the nasal cavity and upper respiratory tract. Primary pulmonary NK/T cell lymphoma is extremely rare. If a patient with a NK or T-cell tumor has an unusual reaction to treatment or an unusual prognosis, it is wise to differentiate NK from T-cell tumors. The clinicopathologic characteristics, immunophenotype, EBV in situ hybridization, and T cell receptor (TCR) gene rearrangement of primary pulmonary NK cell lymphoma from a 73-year-old Chinese woman were investigated and the clonal status was determined using female X-chromosomal inactivation mosaicism and polymorphisms at the phosphoglycerate kinase (PGK) gene. The lesion showed the typical histopathologic characteristics and immunohistochemical features of NK/T cell lymphoma. However, the sample was negative for TCR gene rearrangement. A clonality assay demonstrated that the lesion was monoclonal. It is concluded that this is the first recorded case of genuine primary pulmonary NK cell lymphoma. The purpose of the present work is to recommend that pathologists carefully investigate the whole lesion to reduce the likelihood that primary pulmonary NK cell lymphoma will be misdiagnosed as an infectious lesion. In addition, TCR gene rearrangement and clonal analysis, which is based on female X-chromosomal inactivation mosaicism and polymorphisms at PGK and androgen receptor (AR) loci, were found to play important roles in differentiating NK cell lymphoma from T cell lymphoma. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5205300349457729.
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Affiliation(s)
- Li Gong
- The Helmholtz Sino-German Laboratory for Cancer Research, Department of Pathology, Tangdu Hospital, the Fourth Military Medical University, Shaanxi Xi'an 710038, China.
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25
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Primary Pulmonary T-Cell Lymphoma in a Human T-Lymphotropic Virus Type-1 Carrier Showing Atypical Shadow. J Thorac Oncol 2010; 5:558-9. [DOI: 10.1097/jto.0b013e3181d3cccb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Morovic A, Aurer I, Dotlic S, Weisenburger DD, Nola M. NK cell lymphoma, nasal type, with massive lung involvement: a case report. J Hematop 2010; 3:19-22. [PMID: 21436870 DOI: 10.1007/s12308-009-0050-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 11/17/2009] [Indexed: 11/26/2022] Open
Abstract
Extranodal NK/T cell lymphoma, nasal type, is an Epstein-Barr virus-associated lymphoma that most commonly involves the nasal cavity and upper respiratory tract. Lung involvement by NK/T cell lymphoma is rare and seldom reported in the literature. We describe the unusual case of a 41-year-old male with NK cell lymphoma, nasal type, who presented with massive secondary lung involvement 2.5 years after the detection of a retroperitoneal mass. The diagnosis was made by open lung biopsy. Despite aggressive treatment, the patient died shortly after the initiation of therapy. Lung involvement by NK/T cell lymphoma occurs most commonly as part of widely disseminated disease and carries a poor prognosis for the patient. Novel agents and innovative therapies need to be developed for this aggressive lymphoma.
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27
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Bernabeu Mora R, Sánchez Nieto JM, Nieto Olivares A. Bilateral pulmonary nodules as a manifestation of primary pulmonary T-cell lymphoma. Int J Hematol 2009; 90:153-156. [PMID: 19609646 DOI: 10.1007/s12185-009-0372-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 06/03/2009] [Accepted: 06/10/2009] [Indexed: 11/30/2022]
Abstract
Primary pulmonary lymphoma (PPL) is an uncommon pathology and is usually of the B-cell type, originating in lymphoid tissue associated with the bronchial mucosa (MALT/BALT lymphoma). Very few cases of T-cell PPL, the majority diagnosed by open lung biopsy, have been described in medical literature. We report a case of an immunocompetent patient with fever and bilateral pulmonary nodules, diagnosed with T-cell PPL by transbronchial biopsy. The patient's condition deteriorated and she responded poorly to chemotherapy. PPL should be included in the differential diagnosis of patients with fever and bilateral pulmonary nodules.
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Affiliation(s)
- Roberto Bernabeu Mora
- Pneumology Service, Hospital General Universitario Morales Meseguer, C/Marques de los Vélez, s/n, 30008, Murcia, Spain.
| | - Juan Miguel Sánchez Nieto
- Pneumology Service, Hospital General Universitario Morales Meseguer, C/Marques de los Vélez, s/n, 30008, Murcia, Spain
| | - Andrés Nieto Olivares
- Pathological Anatomy Service, Hospital General Universitario Morales Meseguer, Murcia, Spain
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28
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Tai CF, Chang LY, Lin DT, Lin KH, Jou ST, Yang YL. A case of natural killer cell lymphoma presenting with bilateral pleural effusions and hemophagocytic lymphohistocytosis. Pediatr Blood Cancer 2009; 52:666-9. [PMID: 19156850 DOI: 10.1002/pbc.21943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Natural killer (NK) cell lymphoma of lung is very rare. We report a case of NK cell lymphoma presented in a 17-year-old male with bilateral pleural effusions and hemophagocytic lymphohistocytosis. Morphologic and immunohistochemical tests revealed an association of NK cell lymphoma with Epstein-Barr virus. A literature review helped identify other cases of patients with NK cell lymphoma, their treatment and outcomes.
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Affiliation(s)
- Chun-Fu Tai
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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