Primary Pulmonary T-cell Lymphoma Research Articles

Primary pulmonary T-cell lymphoma mimicking asthma and community-acquired pneumonia: a rare case report

Primary pulmonary T-cell lymphoma (PPTL) is a rare disease. Diagnosing PPTL is challenging due to non-specific clinical symptoms and imaging. A 32-year-old female presented with persistent fever, cough, and dyspnoea. The symptoms were initially treated as asthma and community-acquired pneumonia without improvement. Chest computed tomography (CT) revealed bilateral consolidations with a CT angiogram sign, and flexible bronchoscopy showed infiltrative lesions causing bronchial stenosis. Histopathological examination of the tissue biopsy identified T-cell lymphoma through immunohistochemical staining positive for CD3. This case highlights the importance of considering differential diagnoses such as PPTL in patients with atypical presentations of asthma or non-resolving pneumonia. This case also demonstrates the diagnostic utility of flexible bronchoscopy in identifying airway obstruction due to malignant cells, which can mimic asthma.

TISSUE IS THE ISSUE: CASE OF PRIMARY PULMONARY PERIPHERAL T CELL LYMPHOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Primary pulmonary lymphoma is a rare disease. It accounts for 0.5-1% of all pulmonary malignancy and less than 1 % of all Non-Hodgkins Lymphoma (NHL) (1). Mostly they are of B cell origin; however, there are fourteen reported primary pulmonary peripheral T Cell Lymphoma cases (2). We report a case of a patient presenting with primary pulmonary peripheral T cell Lymphoma. CASE PRESENTATION: A 58-year-old woman presented with complaints of dyspnea, high-grade fever, and cough for the past 4-5 days. Physical exam was unremarkable except for the fever, tachycardia, tachypnea, and oxygen saturation of 87% on room air. Laboratory workup was unremarkable except for elevated ESR, CRP, LDH, and ferritin. Rheumatological workup was unremarkable. Infectious workup, including COVID-19 PCR, blood cultures, and respiratory viral panel, were unremarkable. Chest CT showed bilateral consolidation of lungs with hilar and mediastinal lymphadenopathy (fig 1). She was started on broad-spectrum antibiotics and admitted to the medical floor. Her dyspnea got progressively worse, and she was intubated a week after her admission. Bronchoscopy was done with bronchoalveolar lavage and transbronchial biopsy; however, results were unremarkable. Video-assisted thoracoscopic surgery ( VATS ) was done for mediastinal lymph node biopsy, and biopsy results came positive for peripheral T cell lymphoma(Fig 2, 3 ). Bone marrow biopsy was unremarkable. The patient started to desaturate even on the maximal ventilator setting and was placed on venovenous extracorporeal membrane oxygenation (V-V ECMO). She was given the first cycle of Gemcitabine and oxaliplatin. However, she developed multiorgan failure. She was transitioned to comfort care and expired. DISCUSSION: Primary pulmonary peripheral T cell lymphoma usually manifests with the symptoms of dyspnea, cough, and fever. The mean age of presentation is fifty-three years. Radiographically it presents with lung consolidation, atelectasis, pleural effusion, and multiple nodular lesions. (3) Our patient had bilateral lung consolidation with hilar and mediastinal lymphadenopathy. Diagnosis is made by lobectomy, open lung biopsy, transthoracic needle biopsy, and mediastinal lymph node biopsy. (3) There is still no recommended standard treatment for primary pulmonary T cell lymphoma due to the scarcity of cases (4). Resection, radiotherapy, and chemotherapy are the treatment options used in patients suffering from this disease. CONCLUSIONS: Primary pulmonary peripheral T cell lymphoma is a rare and aggressive cancer. It presents with pneumonia-like symptoms. We recommend clinicians to consider bronchoscopy for those patients with pneumonia who do not get better with antibiotics. REFERENCE #1: Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J. 2002;20(3):750-762. doi:10.1183/09031936.02.00404102 REFERENCE #2: Zhang S, Liang B, Jiang S. Primary pulmonary peripheral T-cell lymphoma: A case report and review of the literature. Thorac Cancer. 2014;5(1):104-107. doi:10.1111/1759-7714.12042 REFERENCE #3: Sangho Lee, Bongkyung Shin, Hyungseok Yoon, Jung Yeon Lee, Gyu Rak Chon, A case of primary pulmonary NK/T cell lymphoma presenting as pneumonia, Respiratory Medicine Case Reports, Volume17,2016, Pages 1-4, ISSN 2213-0071, https://doi.org/10.1016/j.rmcr.2015.11.003. 4) Bernabeu Mora R, Sánchez Nieto JM, Nieto Olivares A. Bilateral pulmonary nodules as a manifestation of primary pulmonary T-cell lymphoma. Int J Hematol. 2009;90(2):153-156. doi:10.1007/s12185-009-0372-8 DISCLOSURES: No relevant relationships by Neil Amin, source=Web Response No relevant relationships by Olufunmilayo Folaranmi, source=Web Response No relevant relationships by Junaid mir, source=Web Response No relevant relationships by Salmaan Mumtaz, source=Web Response No relevant relationships by Ateeb Ur Rahman, source=Web Response

Primary pulmonary T-cell lymphoma with lung adenocarcinoma: a case report

BackgroundPrimary pulmonary T-cell lymphoma is an extremely rare disease that is characterized by neoplastic proliferation of T-cell lymphocytes in the lung.Case presentationAn 88-year-old Japanese woman was admitted to our hospital because of dyspnea. She was treated with antibiotics for chest x-ray findings of consolidation in the upper and middle lobes of the right lung. However, her condition worsened and progressed to respiratory failure, which led to death 14 days after admission. Autopsy of the lungs revealed both T-cell lymphoma and adenocarcinoma.ConclusionsOur patient had a rare case of primary pulmonary T-cell lymphoma with primary lung adenocarcinoma. Further evidence and accumulation of case reports are required to clarify the pathophysiology of primary pulmonary T-cell lymphoma.

気管支鏡下に粘膜病変を観察し得た肺原発 T 細胞性悪性リンパ腫の 1 剖検例

気管支鏡下に粘膜病変を観察し得た肺原発 T 細胞性悪性リンパ腫の 1 剖検例

Primary pulmonary T-cell lymphoma mimicking pneumonia: A case report and literature review.

Primary pulmonary T-cell lymphoma is an extremely rare neoplasm. The present study describes the case of an elderly male patient who was admitted to hospital with initial symptoms including a fever, coughing and dyspnea. A chest computed tomography scan detected pneumonia-like features, including multiple variable nodules, ground-glass opacities, patchy infiltration and subpleural consolidation, which progressed rapidly. No mediastinal or hilar adenopathy was noted. The patient was initially diagnosed with severe pneumonia; however, the patient developed severe respiratory failure and extensive progression in radiographic manifestation despite receiving a combination treatment of broad-spectrum antibiotics and antifungal agents. Negative results were obtained for anti-nuclear antibodies and anti-neutrophil cytoplasmic antibody assays, which eliminated the possibility that the patient was affected by a connective tissue disease. A bronchoscopy with transbronchial lung biopsy was not performed on account of intolerance. A histological examination, which was performed using specimens obtained via video-assisted thoracoscopic surgery, allowed the final diagnosis of T-cell lymphoma to be confirmed. Unfortunately, the patient succumbed to respiratory failure and a probable thoracic hemorrhage prior to the initiation of chemotherapy.

Primary pulmonary peripheral T-cell lymphoma, not otherwise specified: two cases report and literature review

Objective To study the clinical characteristics, diagnosis, treatment and prognosis of primary pulmonary peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Methods Two cases of primary pulmonary PTCL-NOS were studied and relevant literature were reviewed. Results Case 1 diagnosed as primary pulmonary PTCL-NOS was a 44 years old woman and disease progressed after GLD (Gem+L-OHP+DXM) chemotherapy regimen. At last, the patient died of respiratory failure after one month. Case 2 diagnosed as primary pulmonary PTCL-NOS was a 46 years old man and reach partial response after CHOP regimen, and still alive now. Conclusion Primary pulmonary PTCL-NOS is very rare. It is easy to be misdiagnosed due to non-specific clinical and imaging manifestations. Acquiring enough tissue specimens for pathologic examination is the key to a definitive diagnosis. At present, there is no standard chemotherapy regimen for these patients, the prognosis is relatively poor. Key words: Lung neoplasms; Lymphoma, T-cell, peripheral; Prognosis

Primary Pulmonary T-Cell Lymphoma Presenting as Bilateral Interstitial Infiltrates

Primary Pulmonary T-Cell Lymphoma Presenting as Bilateral Interstitial Infiltrates

Primary pulmonary peripheral T-cell lymphoma: A case report and review of the literature.

Primary pulmonary T-cell lymphoma is a rare condition characterized by fever, cough, dyspnea, and bilateral pulmonary nodules, usually diagnosed by transbronchial biopsy or computed tomography (CT) guided needle biopsy and pathology. In view of its poor prognosis, it is critical to distinguish and diagnose this disease as early as possible. We report here a case of a 39-year-old man who presented with fever, cough, expectoration with multiple nodules, and patch shadow in both lungs by chest CT. Tissue samples were taken by CT guided needle biopsy. The histological sample and immunohistochemistry showed peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS). After the patient was treated by chemotherapy for two courses, his condition deteriorated rapidly and he died 2.3 months after the onset of the disease.

An atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome: a case report

BackgroundSjögren’s syndrome is characterized by lymphocytic infiltration of the exocrine glands, together with polyclonal B-cell activation, and lung diseases are well-known complications of the disease. Therefore, in most cases associated with Sjögren’s syndrome, infiltrating lymphocytes in the lung specimen exhibit the features of B-cells. We herein report an atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome.Case presentationA 46-year-old female was admitted to our hospital because of an abnormal chest roentgenogram finding on a medical checkup. Chest computed tomography showed randomly-distributed micronodules and patchy ground-glass opacities. A surgical biopsied specimen showed an atypical pattern of interstitial pneumonia with numerous lymphoid follicles. Among the infiltrating lymphocytes in the lung, only the monoclonality of the T-cells was proven by a gene rearrangement analysis, but there was no cytological atypicality or genetic disorder revealed by testing the bone marrow aspirate. A diagnosis of Sjögren’s syndrome was made based on the patient’s other symptoms and these negative findings. The patient’s pulmonary lesions have been successfully treated and remission has been maintained for over three years with corticosteroid treatment alone.ConclusionThe present patient was an atypical case of lymphoproliferative pulmonary involvement in a patient with Sjögren’s syndrome. Although monoclonality of the infiltrating T-cells was proven, the clinical course and the findings of the imaging and laboratory examinations were inconsistent with the previously-reported cases of primary pulmonary T-cell lymphoma. This suggests that the monoclonality of lymphocytes does not always define malignancy. The diagnosis of malignant lymphoma or lymphoproliferative diseases should be made clinically, pathologically and cytogenetically to rule out other similar diseases.

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

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 …

Primary Pulmonary T-Cell Lymphoma: a Case Report

Primary pulmonary T-cell lymphoma is an extremely rare malady, and we diagnosed this in a 52-year-old male who was admitted to our hospital with cough for the previous two weeks. The chest CT demonstrated multiple variable sized mass-like consolidations with low density central necrosis in the peripheral portion of both the upper and lower lobes. Positron emission tomography (PET) showed multiple areas of hypermetabolic fluorodeoxyglucose (FDG) uptake in both lungs with central metabolic defects, which correlated with central necrosis seen on CT. The histological sample showed peripheral T-cell lymphoma of the not otherwise specified form. The follow-up CT scan showed an increased extent of the multifocal consolidative lesions despite that the patient had undergone chemotherapy.

Bilateral pulmonary nodules as a manifestation of primary pulmonary T-cell lymphoma

Primary pulmonary lymphoma (PPL) is an uncommon pathology and is usually of the B-cell type, originating in lymphoid tissue associated with the bronchial mucosa (MALT/BALT lymphoma). Very few cases of T-cell PPL, the majority diagnosed by open lung biopsy, have been described in medical literature. We report a case of an immunocompetent patient with fever and bilateral pulmonary nodules, diagnosed with T-cell PPL by transbronchial biopsy. The patient's condition deteriorated and she responded poorly to chemotherapy. PPL should be included in the differential diagnosis of patients with fever and bilateral pulmonary nodules.

PULMONARY T-CELL NON-HODGKIN'S LYMPHOMA: CASE REPORT AND REVIEW

INTRODUCTION:Primary pulmonary lymphomas represent only 4 percent of all Non Hodgkin's lymphomas. Most of the T-cell derived lymphomas arise in the thymus, skin or nasal cavity and primary T-cell lymphoma of the lung is rare. We report a case of primary pulmonary T-cell lymphoma.

Primary Pulmonary T-cell Lymphoma in an HTLV-1 Carrier

Background. The incidence of primary pulmonary lymphomas is only 0.34%, and peripheral T-cell lymphoma is very rare. Moreover, there is no literature recording its appearance in a Human T lymphotropic virus type 1 (HTLV-1) carrier. Case. A 65-year old man with dry cough, fever, and chills was admitted with multiple pulmonary nodules and pleural effusion. High lymphocyte count and elevated adenosine deaminase (ADA) were found in the pleural effusion. Antitubercular therapy yielded no clinical or radiologic improvement. The patient was transferred to our hospital where lymphoma was confirmed from positive rearrangement of the TCR-β gene in cells in the pleural effusion. The patient was positive for HTLV-1 antibody, but did not have monoclonal integration of the pro-virus HTLV-1 in cells in the pleural effusion. Conclusion. This was the first case of an HTLV-1 carrier presenting with primary pulmonary T cell lymphoma.

Primary T-cell Lymphoma of the Lun

INTRODUCTION: Primary lymphoma of the lung is rare and most are B-cells. We present a case of primary pulmonary T-cell lymphoma (PTCL).

AIDS lymphoma.

Most AIDS-related non-Hodgkin's lymphomas can be categorized into one of three histologic subtypes: large-cell immunoblastic, small non-cleaved cell (Burkitt's or Burkitt's-like) and diffuse large cell. Rare histologies include Ki-1 anaplastic large cell lymphoma, angiotropic large cell lymphoma, mucosa-associated lymphoid tissue, primary pulmonary T-cell lymphoma, and Sézary syndrome. Although the role of Epstein-Barr virus remains uncertain, a new herpes virus, human herpes virus 8, has been identified in the rare subset of effusion-based lymphomas. Overexpression of the cytokines interleukin-6 and interleukin-10 may have a role in pathogenesis, and they may serve as potential therapeutic targets. In addition, chronic antigenic stimulation may correlate with elevated serum CD22 levels and may serve as a tool for early detection. Novel investigational therapies in clinical development include new chemotherapy-based regimens, immune modulators, antibody therapy, as well as cellular therapy.

Primary pulmonary T-cell lymphoma associated with AIDS: The syndrome of the indolent pulmonary mass lesion

Christine A. Kohler, MD, Albert Einstein school of Medicine, Bronx, New York, Emilio Gonzalez-Ayala, MD, Baylor University College of Medicine, Houston, Texas, Patricia Rowley, MD, Texas Tech University Health Sciences Center, El Paso, Texas, Fernando Malamud, MD, University of Mississippi School of Medicine, Jackson, Mississippi, Abraham Verghese, MD, FRCP(C), FACP, Texas Tech University Health Sciences Center, El Paso, Texas