Abstract
BackgroundThe occurrence of malignant lymphoma after delivery is an extremely rare event. Although several cases of Hodgkin lymphoma and B cell lymphoma and a few cases of peripheral T cell lymphoma (PTCL) after delivery have been reported, there are no report of autopsy cases of PTCL in the puerperal period.Case presentationA 32-year-old Japanese woman with a past medical history of atopic dermatitis and bronchial asthma presented with generalized eruptions four days after the delivery of her first child; generalized skin induration and lymphadenopathy subsequently emerged. A skin biopsy specimen showed the diffuse proliferation of atypical lymphoid cells that were immunohistochemically-positive for CD4 but negative for CD8. She was diagnosed as PTCL, not otherwise specified (PTCL, NOS). She died one year and three months after the onset of symptoms. At autopsy, the systemic infiltration of lymphoma cells into the whole body was observed. Unexpectedly, these lymphoma cells were immuno-reactive with CD8 but not with CD4.ConclusionThe occurrence and development of PTCL after delivery with the shift from CD4 positivity to CD8 positivity may be associated with not only the selection of resistant subclone as a result of chemotherapy but also the changes of immune status before and after delivery.
Highlights
The occurrence of malignant lymphoma after delivery is an extremely rare event
Reactive lymphoid cell proliferation and malignant lymphoma were considered as differential diagnosis, lymphoproliferative disorder associated with atopic dermatitis and delivery was initially suspected based on the time course of her problems
T helper 1 (Th1) cells induce cytotoxic and inflammatory reactions which are mediated by some cytokines such as interleukin 2 (IL-2), interferon γ (IFN-γ), tumor necrosis factor β (TNF-β) and IL-12, while T helper 2 (Th2) cells secrete IL-4, IL-5, IL-6, IL-9 and IL-10, which are associated with B cell antibody production
Summary
The occurrence and development of PTCL after delivery with the shift from CD4 positivity to CD8 positivity may be associated with the selection of resistant subclone as a result of chemotherapy and the changes of immune status before and after delivery.
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