A Case of High-grade T-cell Lymphoma With Extensive Involvement of Trachea

Résumé fourni par la source

Peripheral T-cell lymphomas (PTCLs) are a group of heterogenous non-Hodgkin lymphoma (NHL). Its involvement of the pulmonary system and trachea is rare. Prior case reports have described endobronchial or tracheal mass as the clinical manifestation.1,2 We report a unique manifestation of the lymphoma involving the airways. CASE REPORT A 76-year-old man presented with a 4-week history of runny nose, productive cough with clear sputum, and sore throat. His past medical history was significant for hypertension and diabetes mellitus. He was an active smoker with a 20-pack-year smoking history. On examination, there was a palpable left anterior cervical lymph node of 1 cm in diameter with firm consistency and no overlying skin abnormality. He had a chest x-ray that showed a right hilar mass. Computed tomography scan of the thorax revealed a large right hilar mass measuring 5.1×5.0 cm with narrowing of the right upper lobe bronchus (Fig. 1). There were enlarged mediastinal and hilar lymph nodes. Positron emission tomography/computed tomography scan demonstrated increased fluorodeoxyglucose uptake in the nasopharynx, oropharynx, base of the tongue, and the tonsils, with an SUVmax of 15.7. There was also an increased fluorodeoxyglucose uptake in bilateral cervical, submandibular, paratracheal, aortopulmonary window and bilateral hilar lymph nodes, and involving the right hilar mass. The left upper lobe nodule, bilateral lung pleura, and abdominal lymph nodes were also hypermetabolic.FIGURE 1: Computed tomography scan of the thorax. Large right hilar mass with narrowing of the right upper lobe bronchus.Fine-needle aspiration of the cervical lymph node showed features of high-grade T-cell lymphoma. The neoplastic cells were positive for LCA (CD45), CD3, CD2, and CD30, and negative for CD7 and ALK, consistent with PTCL of the anaplastic variant. As the patient had large right hilar mass and narrowing of the right upper lobe bronchus, there was concern for a concomitant primary lung cancer. Bronchoscopy was performed that showed patchy, annular, erythematous plaques diffusely present over the tracheal mucosa (Fig. Aa). There was also an erythematous, friable endobronchial mass partially obstructing the right mainstem bronchus (Fig. Ab). The mass was biopsied, and histopathology was consistent with high-grade T-cell lymphoma.FIGURE A: Bronchoscopy image. Tracheal mucosa showing patchy, annular, erythematous plaques (a) and endobronchial mass in the right mainstem (b).DISCUSSION T-cell lymphomas are broadly divided into cutaneous and noncutaneous (peripheral) type. PTCLs constitute 5% to 10% of NHL.3 It is more common in Asia than in the West.4 The reason for this difference is attributed to geographic and ethnic variability.4 Exposure to environmental and certain infectious agents like human T-cell lymphotropic virus type-1 and Epstein-Barr virus is one of the reasons for geographic variation.5 Median age at diagnosis is 59 years. PTCL is a heterogenous group of NHL that results from involvement of postthymic T cells or natural killer cells, which can occur at nodal or extranodal sites.5 PTCL generally presents with lymphadenopathy, and presentation can vary from being asymptomatic to significant organ involvement. Extranodal presentation is common in PTCL and often contributes to a delay in the diagnosis. Bone marrow is the most common site of involvement. Pulmonary involvement is reported in 3% to 24% of cases and pleural effusion in 3% to 12% of cases.6 The common radiologic manifestations of pulmonary involvement are parenchymal mass-like consolidations, small nodules, interstitial infiltrates, peribronchial and perivascular thickening, hilar or mediastinal lymph node enlargement, and pleural effusions.7 PTCL presenting as endobronchial lesion is rare but has been reported.1 Anaplastic large cell lymphoma is the only aggressive PTCL that shows a favorable prognosis using CHOP [cyclophosphamide, hydroxydaunomycin, vincristine (Oncovin), and prednisone]-like regimens.8 CONCLUSION Airway involvement due to T-cell lymphoma can present as erythematous plaques and endobronchial mass with minimal symptoms.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.