A 68-Year-Old Man With Shortness of Breath and Peripheral Edema

Abstract

We report a case of angioimmunoblastic T-cell lymphoma in a patient who presented with the typical clinical features of generalized lymphadenopathy: bilateral pleural effusions, splenomegaly, ascites, and polyclonal hypergammaglobulinemia. Angioimmunoblastic T-cell lymphoma is one of the more specific peripheral T-cell lymphomas accounting for approximately 15% to 20% of cases and approximately 1% to 2% of all non-Hodgkin lymphomas. Involved lymph nodes reveal partial effacement of normal architecture by a polymorphic infiltrate composed of small-to-intermediate-sized lymphocytes, plasma cells, eosinophils, and histiocytes with prominent proliferation of high endothelial venules and follicular dendritic cells. Neoplastic T cells are small to intermediate in size, show abundant clear cytoplasm with distinct membranes, are predominantly CD4 positive, and often show aberrant coexpression of CD10. The clinical course is aggressive, with a median survival of less than 3 years. Most patients succumb to infectious complications rather than tumor burden, making the administration of aggressive chemotherapy difficult.