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T-cell lymphoblastic lymphoma presenting with pleural effusion: A case report.

He XL, Yu F, Guo T, Xiang F, Tao XN, Zhang JC, Zhou Q - Respir Med Case Rep (2014)

Bottom Line: After a medical thoracoscopy, the partial pleura was picked and immunophenotypic study revealed the following: CD3(+), TdT(+), CD99(+), CD20(-).The patient was finally diagnosed with T-LBL and died only 6 months after that.The case highlight the point that medical thoracoscopy is a safe and accurate diagnostic procedure for pleural diseases, and partial pleura biopsy with immunophenotyping was essential for achieving the correct diagnosis of LBL.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

ABSTRACT
Adult lymphoblastic lymphoma (LBL) is an aggressive form of non-Hodgkin lymphoma occurring in predominantly adolescent and young adult men, accounting for 1% to 2% of all non-Hodgkin's lymphomas. In contrast to B-LBL, T-cell LBL is much more common, accounting for up to 90% of disease in adults. Mediastinal mass, pleural and/or pericardial effusions are the major characteristics of T-LBL. We report an 18-year-old male with a pleural effusion, mediastinal mass, a light pericardial effusion, and a normal hemogram. The cytology of the pleural effusion initially suggested malignancy, but definitive diagnosis was unclear. After a medical thoracoscopy, the partial pleura was picked and immunophenotypic study revealed the following: CD3(+), TdT(+), CD99(+), CD20(-). The patient was finally diagnosed with T-LBL and died only 6 months after that. The case highlight the point that medical thoracoscopy is a safe and accurate diagnostic procedure for pleural diseases, and partial pleura biopsy with immunophenotyping was essential for achieving the correct diagnosis of LBL.

No MeSH data available.


Related in: MedlinePlus

Chest computed tomography view of the patient. Chest CT showed left-sided pleural effusion, an anterior and middle mediastinal mass (B, D, F, white arrow) which resulted in contralateral shift and stricture of the tracheal (A, black arrow) and left mainstem bronchus stricture (C, black arrow). Chest CT at the level of heart demonstrating pleural thickening of the left hemithorax, left-sided pleural effusion and a light pericardial effusion (E, F).
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fig2: Chest computed tomography view of the patient. Chest CT showed left-sided pleural effusion, an anterior and middle mediastinal mass (B, D, F, white arrow) which resulted in contralateral shift and stricture of the tracheal (A, black arrow) and left mainstem bronchus stricture (C, black arrow). Chest CT at the level of heart demonstrating pleural thickening of the left hemithorax, left-sided pleural effusion and a light pericardial effusion (E, F).

Mentions: Chest X-ray demonstrates a large anterior mediastinal mass and a left pleural effusion with a light contralateral shift of the trachea and mediastinum (Fig. 1). Chest computed tomography (CT) showed an anterior and middle mediastinal mass with a light contralateral shift of the trachea, pleural thickening of the left hemithorax, and left-sided pleural effusion (Fig. 2). Chest ultrasonography revealed massive left pleural effusion. Echocardiography showed little pericardial effusion. And ultrasonography of superficial lymph node showed lymphadenopathy in bilateral axillary region (left 21.1 × 11.4 mm; right 15.4 × 4.4 mm), bilateral cervical region, (left, 18.7 × 17.1 mm; right 12 × 5.2 mm), and bilateral inguinal region (left 16 × 4.8 mm; right 11.3 × 9.3 mm), but not in retroperitoneal region. Thoracentesis were performed and revealed exudate with lactate dehydrogenase level of 721 U/L, ADA value of 25 U/L, and TP 15.3 g/L. Pleural fluid were grossly bloody and the routine examination of pleural fluid showed leukocytes 5 × 109/L (55% percent multinucleated cells, 54% percent mononuclear cells). The cytologic examination of the effusion smears revealed massive lymphocytes, a small amount of mesothelial cells, and partly abnormal cells (tumor cell?). Pleural fluid cultures were negative for M. tuberculosis.


T-cell lymphoblastic lymphoma presenting with pleural effusion: A case report.

He XL, Yu F, Guo T, Xiang F, Tao XN, Zhang JC, Zhou Q - Respir Med Case Rep (2014)

Chest computed tomography view of the patient. Chest CT showed left-sided pleural effusion, an anterior and middle mediastinal mass (B, D, F, white arrow) which resulted in contralateral shift and stricture of the tracheal (A, black arrow) and left mainstem bronchus stricture (C, black arrow). Chest CT at the level of heart demonstrating pleural thickening of the left hemithorax, left-sided pleural effusion and a light pericardial effusion (E, F).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4061434&req=5

fig2: Chest computed tomography view of the patient. Chest CT showed left-sided pleural effusion, an anterior and middle mediastinal mass (B, D, F, white arrow) which resulted in contralateral shift and stricture of the tracheal (A, black arrow) and left mainstem bronchus stricture (C, black arrow). Chest CT at the level of heart demonstrating pleural thickening of the left hemithorax, left-sided pleural effusion and a light pericardial effusion (E, F).
Mentions: Chest X-ray demonstrates a large anterior mediastinal mass and a left pleural effusion with a light contralateral shift of the trachea and mediastinum (Fig. 1). Chest computed tomography (CT) showed an anterior and middle mediastinal mass with a light contralateral shift of the trachea, pleural thickening of the left hemithorax, and left-sided pleural effusion (Fig. 2). Chest ultrasonography revealed massive left pleural effusion. Echocardiography showed little pericardial effusion. And ultrasonography of superficial lymph node showed lymphadenopathy in bilateral axillary region (left 21.1 × 11.4 mm; right 15.4 × 4.4 mm), bilateral cervical region, (left, 18.7 × 17.1 mm; right 12 × 5.2 mm), and bilateral inguinal region (left 16 × 4.8 mm; right 11.3 × 9.3 mm), but not in retroperitoneal region. Thoracentesis were performed and revealed exudate with lactate dehydrogenase level of 721 U/L, ADA value of 25 U/L, and TP 15.3 g/L. Pleural fluid were grossly bloody and the routine examination of pleural fluid showed leukocytes 5 × 109/L (55% percent multinucleated cells, 54% percent mononuclear cells). The cytologic examination of the effusion smears revealed massive lymphocytes, a small amount of mesothelial cells, and partly abnormal cells (tumor cell?). Pleural fluid cultures were negative for M. tuberculosis.

Bottom Line: After a medical thoracoscopy, the partial pleura was picked and immunophenotypic study revealed the following: CD3(+), TdT(+), CD99(+), CD20(-).The patient was finally diagnosed with T-LBL and died only 6 months after that.The case highlight the point that medical thoracoscopy is a safe and accurate diagnostic procedure for pleural diseases, and partial pleura biopsy with immunophenotyping was essential for achieving the correct diagnosis of LBL.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

ABSTRACT
Adult lymphoblastic lymphoma (LBL) is an aggressive form of non-Hodgkin lymphoma occurring in predominantly adolescent and young adult men, accounting for 1% to 2% of all non-Hodgkin's lymphomas. In contrast to B-LBL, T-cell LBL is much more common, accounting for up to 90% of disease in adults. Mediastinal mass, pleural and/or pericardial effusions are the major characteristics of T-LBL. We report an 18-year-old male with a pleural effusion, mediastinal mass, a light pericardial effusion, and a normal hemogram. The cytology of the pleural effusion initially suggested malignancy, but definitive diagnosis was unclear. After a medical thoracoscopy, the partial pleura was picked and immunophenotypic study revealed the following: CD3(+), TdT(+), CD99(+), CD20(-). The patient was finally diagnosed with T-LBL and died only 6 months after that. The case highlight the point that medical thoracoscopy is a safe and accurate diagnostic procedure for pleural diseases, and partial pleura biopsy with immunophenotyping was essential for achieving the correct diagnosis of LBL.

No MeSH data available.


Related in: MedlinePlus