出血性脳梗塞で発症したＴ‐ｃｅｌｌ ａｎｇｉｏｔｒｏｐｉｃ ｌｙｍｐｈｏｍａの１剖検例

Abstract

We report here an autopsy case of T-cell angiotropic lymphoma with atypical clinical course. A 47-year-old male was admitted because of a speech disturbance. His brain CT revealed intracerebral hemorrhage, and an evacuation of intracranial hematoma was performed. The examination of the brain tissue resected at the operation showed hemorrhagic cerebral infarction. He was discharged on the 25th postoperative day without symptoms. Four weeks later, he was re-admitted because of high fever and dyspnea on effort. His laboratory findings showed mild hypoxemia and elevated serum LDH (6075IU). Six days after the admission, he abruptly presented tonic convulsion. His brain CT revealed hemorrhage in the left occipital lobe, and he admitted to NCU. Though steroid pulse therapy and artificial respiration were performed, respiratory failure and DIC progressed, and he died fifteen days after the admission.At autopsy, the histological examination showed a multifocal proliferation of lymphoma cells within the lumens of small blood vessels in almost all of the organs. These tumor cells had T-cell surface markers, so final pathological diagnosis was T-cell angiotropic lymphoma.Most cases of angiotropic lymphoma (neoplastic angioendotheliosis) reported in the literature are derived from B-cell lymphoma, and T-cell angiotropic lymphoma is very rare.The clinical course of our case was a rapidly progressive one, and he presented various symptoms such as hemorrhagic cerebral infarction, respiratory failure and DIC. This is the first report of intracranial hemorrhage in angiotropic lymphoma.