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Han P, Yang L, Yan W, Tian D. Angioimmunoblastic T-cell lymphoma mimicking drug fever and infectious etiology after a thyroidectomy: A case report. Medicine (Baltimore) 2019; 98:e16932. [PMID: 31441883 PMCID: PMC6716746 DOI: 10.1097/md.0000000000016932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of mature peripheral T-cell lymphoma and accounts for approximately 1% to 2% of non-Hodgkin lymphomas. Although the B symptoms with generalized lymphadenopathy are the most frequent manifestations of AITL, its diagnosis remains a challenge as clinical manifestations and pathological features are frequently misleading. PATIENT CONCERNS We report herein the case of a 70-year-old man with intermittent fever, pulmonary infection, and skin rash developed for 1 month before admission. Previously, he had undergone thyroidectomy for thyroid papillary carcinoma. Fever occurred on the day of discharge and occurred again during the next month. Symptoms worsened despite treatment with antibiotics and papular rash appeared. The local hospital diagnosed it as drug fever and stopped all antibiotics. Fever and rash were controlled temporarily; however, both relapsed 2 days before admission. On the night of admission, the patient developed fever again. Blood culture showed Staphylococcus epidermidis and Staphylococcus haemolyticus infection. INTERVENTIONS Taking into account the recent history of surgery, the patient was diagnosed with septicemia and was treated with anti-infective treatment. On 13th day after admission, the patient developed fever again accompanied by generalized lymphadenopathy. However, multiple blood cultures were negative and bone marrow aspiration cytology, biopsy, immunohistochemistry, and gene rearrangement results were normal. DIAGNOSIS The patient was finally subjected to cervical lymph node biopsy and was diagnosed with AITL. OUTCOMES The patient was transferred to the Department of Hematology for further treatment. CONCLUSION This case highlights the complex diagnostic challenges of AITL. AITL accompanied by thyroid carcinoma may not be a mere coincidence and administration of antibiotics may be a rare cause of AITL.
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Affiliation(s)
- Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Yang
- Department of Ultrasound, The Fifth People's Hospital of Nanchong, Nanchong, China
| | - Wei Yan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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B2 microglobulin is a novel prognostic marker of Angioimmunoblastic T-cell lymphoma. Sci Rep 2018; 8:12907. [PMID: 30150635 PMCID: PMC6110724 DOI: 10.1038/s41598-018-31212-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/08/2018] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to analyze features and explore parameters that can help to predict prognosis for angioimmunoblastic T-cell lymphoma (AITL). A total of 117 patients with AITL were retrospectively analyzed. Multivariate analysis showed that β2 microglobulin (β2-M) ≥4.0 mg/L (P = 0.020), rash/pruritus (P = 0.004), performance status (PS) ≥2 (P = 0.006), age >60 years (P = 0.006) and extranodal sites (ENSs) >1 (P = 0.029) were independent risk factors for OS. Rash/pruritus (P = 0.007), age >60 years (P = 0.035) and ENSs >1 (P = 0.006) were independent risk factors for PFS. A novel prognostic model consisting of β2-M, rash/pruritus, PS, age and ENSs >1 was constructed. The model classified patients into 3 risk stratifications: low risk (0 or 1 factor), intermediate risk (2 factors), high risk (≥3 factors) and significantly stratified patients with AITL (P < 0.001). In conclusion, except for PS ≥2, age >60 years and ENSs >1 used in IPI, β2-M and rash/pruritus also indicated adverse prognosis. That we constructed model was commendably prognostic for OS and PFS.
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Pan Z, Chen M, Zhang Q, Wang E, Yin L, Xu Y, Huang Q, Yuan Y, Zhang X, Zheng G, Yuan J. CD3-positive plasmablastic B-cell neoplasms: a diagnostic pitfall. Mod Pathol 2018; 31:718-731. [PMID: 29327711 DOI: 10.1038/modpathol.2017.177] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
Rare B-cell neoplasms with plasmablastic differentiation may aberrantly express CD3 by immunohistochemical staining, which places a great challenge for diagnosis. We here studied 17 cases of CD3+ plasmablastic B-cell neoplasms, including 12 plasmablastic lymphomas and 5 plasmablastic plasma cell myelomas. All 17 cases occurred in the extranodal sites with a male predominance (13/17). Four cases were initially misinterpreted by outside institutions, among which three were diagnosed as 'peripheral T-cell lymphoma, not otherwise specified' and one was classified as 'poorly differentiated neuroendocrine carcinoma'. The plasmablastic cells were present in all 17 cases diffusely or in a subset of tumor cells. CD3 expression was mostly diffuse (12/17) and moderate to strong (11/16) with a cytoplasmic staining pattern (14/16). Other T-cell markers were nearly absent, including CD2 (0/10), CD4 (1/13), CD5 (0/14), CD7 (0/11), and CD8 (0/13). CD138 was positive in all 17 cases and CD79a was variably positive in 8 of 14 cases. Only one case had immunoreactivity to CD20 (1/17) and PAX5 (1/12). CD56 expression and EBV infection were detected in 8/15 and 6/17, respectively. No HHV8 infection was noted in all 11 cases tested. Most cases (11/13) revealed either kappa or lambda light chain restriction. Of the nine cases studied, six had clonal IGH rearrangements but no clonal TRG rearrangements. Our study further emphasizes that the accurate classification of CD3+ plasmablastic neoplasms requires thorough morphologic examination, incorporation of more B-cell and T-cell markers in addition to CD3 and CD20, frequent addition of CD138 staining, and utilization of necessary molecular and genetic studies.
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Affiliation(s)
- Zenggang Pan
- Department of Pathology, University of Colorado Denver, Aurora, CO, USA
| | - Mingyi Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qianyun Zhang
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Liqun Yin
- Incyte Diagnostics, Spokane Valley, WA, USA
| | - Youyuan Xu
- Department of Pathology, Woodhull Medical and Mental Health Center, Brooklyn, NY, USA
| | - Qin Huang
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Youzhong Yuan
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xiaohui Zhang
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gang Zheng
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Ji Yuan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
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Toya T, Nannya Y, Hangaishi A, Shiseki M, Shimoyama T, Sakamaki H, Motoji T, Usuki K, Nakamura F, Kurokawa M. Prognostic relevance of CD20 expression in peripheral T-cell lymphomas: a multi-center retrospective study. Leuk Lymphoma 2015; 57:961-4. [PMID: 26366623 DOI: 10.3109/10428194.2015.1083097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Takashi Toya
- a Department of Hematology & Oncology , The University of Tokyo , Tokyo , Japan
| | - Yasuhito Nannya
- a Department of Hematology & Oncology , The University of Tokyo , Tokyo , Japan
| | - Akira Hangaishi
- b Department of Hematology , NTT Medical Center Tokyo , Tokyo , Japan
| | - Masayuki Shiseki
- c Department of Hematology , Tokyo Women's Medical University , Tokyo , Japan
| | - Tatsu Shimoyama
- d Department of Medical Oncology , Tokyo Metropolitan Cancer and Infection diseases Center Komagome Hospital , Tokyo , Japan
| | - Hisashi Sakamaki
- d Department of Medical Oncology , Tokyo Metropolitan Cancer and Infection diseases Center Komagome Hospital , Tokyo , Japan
| | - Toshiko Motoji
- c Department of Hematology , Tokyo Women's Medical University , Tokyo , Japan
| | - Kensuke Usuki
- b Department of Hematology , NTT Medical Center Tokyo , Tokyo , Japan
| | - Fumihiko Nakamura
- a Department of Hematology & Oncology , The University of Tokyo , Tokyo , Japan
| | - Mineo Kurokawa
- a Department of Hematology & Oncology , The University of Tokyo , Tokyo , Japan
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Tsai YC, Chen CK, Wu YH. CD20-Positive nodal natural killer/T-cell lymphoma with cutaneous involvement. J Cutan Pathol 2015; 42:639-44. [DOI: 10.1111/cup.12502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/25/2015] [Accepted: 04/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Yi-Chiun Tsai
- Department of Dermatology; Mackay Memorial Hospital; Taipei Taiwan
| | - Chi-Kuan Chen
- Department of Pathology; Mackay Memorial Hospital; Taipei Taiwan
- Department of Medicine; Mackay Medical College; New Taipei City Taiwan
| | - Yu-Hung Wu
- Department of Dermatology; Mackay Memorial Hospital; Taipei Taiwan
- Department of Medicine; Mackay Medical College; New Taipei City Taiwan
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Zou F, Li Z, Ma JA, Qiu Z, Tang YF, Zheng JY. T-cell lymphoma with POEMS syndrome. Oncol Lett 2015; 9:1313-1316. [PMID: 25663904 PMCID: PMC4315070 DOI: 10.3892/ol.2014.2810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 11/21/2014] [Indexed: 12/27/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a unique subtype of peripheral T-cell lymphoma. POEMS syndrome is a rare paraneoplastic syndrome caused by an underlying plasma cell disorder (PCD). The occurrence of AITL with POEMS syndrome has rarely been reported in the literature. The current study presents the case of a 53-year-old male who presented with a rapidly proliferative lymph node on the left neck, which was identified as an AITL on biopsy. The patient also exhibited the complications of polyneuropathy, M-proteinemia, hepatosplenomegaly, left ventricular hypertrophy, endocrinopathy and skin changes, and was therefore diagnosed with POEMS syndrome. To the best of our knowledge, the present study is the first to report a case of AITL with POEMS syndrome. The findings in this case suggest that the aberrant clones of B cells can also be caused by AITL.
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Affiliation(s)
- Fangwen Zou
- Department of Oncology, Xiangya Second Hospital of Center South University, Changsha, Hunan 410011, P.R. China
| | - Zhenhua Li
- Department of Oncology, Xiangya Second Hospital of Center South University, Changsha, Hunan 410011, P.R. China
| | - Jin-An Ma
- Department of Oncology, Xiangya Second Hospital of Center South University, Changsha, Hunan 410011, P.R. China
| | - Zhenhua Qiu
- Department of Oncology, Xiangya Second Hospital of Center South University, Changsha, Hunan 410011, P.R. China
| | - Yi-Fang Tang
- Department of Oncology, Xiangya Second Hospital of Center South University, Changsha, Hunan 410011, P.R. China
| | - Jiao-Yun Zheng
- Department of Pathology, Xiangya Second Hospital of Center South University, Changsha, Hunan 410011, P.R. China
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Banz Y, Krasniqi F, Dirnhofer S, Tzankov A. Relapsed angioimmunoblastic T-cell lymphoma with acquired expression of CD20: a case report and review of the literature. BMC Clin Pathol 2013; 13:18. [PMID: 23738899 PMCID: PMC3680012 DOI: 10.1186/1472-6890-13-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/29/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma is one of the most common types of peripheral T-cell lymphomas, usually presenting at an older age with an aggressive clinical course. Its characteristic morphological presentation and follicular helper T-cell phenotype help to distinguish it from other T-cell lymphomas. CASE PRESENTATION We recently encountered the unique case of a 63-year old patient with relapsed tumour-cell rich angioimmunoblastic T-cell lymphoma, presenting with a "classical" phenotype and, in addition, an acquired, strong, aberrant expression of CD20."Lineage infidelity" of phenotypic markers is a well-documented phenomenon in lymphomas and leukemias, a circumstance currently still poorly understood and with the potential to bring about erroneous interpretations, causing diagnostic havoc. This case represents one of the few documented angioimmunoblastic T-cell lymphomas with strong CD20 expression. Of interest, CD20 expression was only detected in the recurrent lymphoma and not upon initial diagnosis. The clinical importance of this finding lies in the potential for treatment with an anti-CD20 antibody, for instance Rituximab, in addition to standard chemotherapy protocols for angioimmunoblastic T-cell lymphoma. CONCLUSION Diagnostic work-up of lymphomas to determine their lineage should therefore consider morphology, pheno- as well as genotypic characteristics, where appropriate, and in particular signs of progression and change in marker profile in relapsed cases e.g. acquisition of "non-lineage" markers such as CD20 in T-cell lymphoma.
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Affiliation(s)
- Yara Banz
- Institute of Pathology, University Hospital Basel, Schönbeinstrasse 4, 4031, Basel, Switzerland.
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