Primary pulmonary extranodal natural killer/T-cell lymphoma: nasal type with multiple nodules

Abstract

To the Editors: Primary pulmonary lymphoma (PPL) is an uncommon disease representing only 3–4% of extranodal non-Hodgkin’s lymphoma (NHL), and <1% of NHL [1]. The true incidence of PPL other than NHL is unknown, while primary pulmonary T-cell lymphoma is extremely rare. Natural killer (NK)/T-cell lymphoma usually shows an extranodal presentation. Nasal NK/T-cell lymphomas occur in the nose and the upper aerodigestive tract. Extranasal NK/T-cell lymphomas represent the counterpart of nasal NK/T-cell lymphomas and can involve every other part of the body. Primary sites of involvement are mainly the skin, soft tissue, gastrointestinal tract and testis [2]. Although some cases of primary pulmonary T-cell lymphoma have been reported, there are only two reports written in English to date [3, 4]. Here, we describe a case of primary pulmonary NK/T-cell lymphoma with multiple nodules in both lung fields. The patient was a 50-yr-old Japanese male with an abnormal shadow on chest radiography in a health examination (fig. 1a). He was an office worker with no history of dust inhalation or asbestos exposure and was a current smoker (50 pack-yrs). He had a history of hypertension and gallstones. He had a high fever of over 39°C for 10 days before the health examination, and had appetite loss and general fatigue. A chest computed tomography (CT) on admission revealed multiple nodules, measuring a maximum of 40 mm in size, were in both lung fields (fig. 1b–d). Administration of broad-spectrum antibiotics did not resolve his symptoms. Bronchoscopic examination and CT-guided needle biopsy did not give a definite diagnosis. Laboratory data showed elevation of lactate dehydrogenase, transaminases, hepatobiliary enzymes and an inflammatory reaction without cytopenia. Two sets of blood …