Peripheral T-cell lymphoma unspecified type presenting with a pneumothorax as the initial manifestation: A case report and literature review

Fu,Tianhong; Yang,Wei; Zhang,Xuejin; Xu,Xiaofeng

doi:10.3892/ol.2016.4518

Peripheral T-cell lymphoma unspecified type presenting with a pneumothorax as the initial manifestation: A case report and literature review

Authors:
- Tianhong Fu
- Wei Yang
- Xuejin Zhang
- Xiaofeng Xu
View Affiliations

Affiliations: Division of Pathology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang 310003, P.R. China, Division of Hematology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang 310003, P.R. China
Published online on: May 4, 2016 https://doi.org/10.3892/ol.2016.4518
Pages: 4069-4076

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study describes the case of a 51-year-old male presenting with a pneumothorax, in whom a final diagnosis of peripheral T-cell lymphoma unspecified type (PTCL-u) was determined. As the patient had experienced a shortness of breath subsequent to exercise for a period of 2 months, a fiber bronchoscopy was performed; however, no abnormalities were initially identified. Following the bronchoscopy, the patient suffered a recurrent pneumothorax with symptoms of emaciation, night sweats and a fever. The combination of computed tomography and interstitial lung pathology results suggested a high probability of malignant lymphoma. Further test results confirmed this diagnosis, including the fiber bronchoscopy biopsy report, which indicated a large amount of lymphocyte aggregation, and an ultrasound that identified several supraclavicular and left submandibular enlarged lymph nodes (largest size, 2.3x1.3 cm), with an absent hilar lymph node. A biopsy of the left cervical lymph node was performed, with post-operative pathological analysis confirming a diagnosis of peripheral T‑cell lymphoma unspecified (stage IVB). The patient received two cycles of CHOP chemotherapy, and the symptoms alleviated following completion of the treatment, with chest radiography indicating that the pneumothorax had disappeared. The patient subsequently refused further treatment due to financial difficulty, and succumbed to the disease 6 months later.

View Figures

View References

1.	Vose J and Armitage J: and Weisenburger. International T-Cell Lymphoma Project: International peripheral T-cell and natural killer/T-cell lymphoma study: Pathology findings and clinical outcomes. J Clin Oncol. 26:4124–4130. 2008. View Article : Google Scholar : PubMed/NCBI
2.	Federico M, Rudiger T, Bellei M, Nathwani BN, Luminari S, Coiffier B, Harris NL, Jaffe ES, Pileri SA, Savage KJ, et al: Clinicopathologic characteristics of angioimmunoblastic T-cell lymphoma: Analysis of the international peripheral T-cell lymphoma project. J Clin Oncol. 31:240–246. 2013. View Article : Google Scholar : PubMed/NCBI
3.	Lunning MA, Moskowitz AJ and Horwitz S: Strategies for relapsed peripheral T-cell lymphoma: The tail that wags the curve. J Clin Oncol. 31:1922–1927. 2013. View Article : Google Scholar : PubMed/NCBI
4.	Schmitz N, Trümper L, Ziepert M, Nickelsen M, Ho AD, Metzner B, Peter N, Loeffler M, Rosenwald A and Pfreundschuh M: Treatment and prognosis of mature T-cell and NK-cell lymphoma: An analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group. Blood. 116:3418–3425. 2010. View Article : Google Scholar : PubMed/NCBI
5.	Rodríguez J, Conde E, Gutiérrez A, Arranz R, León A, Marín J, Bendandi M, Albo C and Caballero MD: The results of consolidation with autologous stem-cell transplantation in patients with peripheral T-cell lymphoma (PTCL) in first complete remission: The Spanish Lymphoma and Autologous Transplantation Group experience. Ann Oncol. 18:652–657. 2007. View Article : Google Scholar : PubMed/NCBI
6.	Feyler S, Prince HM, Pearce R, Towlson K, Nivison-Smith I, Schey S, Gibson J, Patton N, Bradstock K, Marks DI and Cook G: The role of high-dose therapy and stem cell rescue in the management of T-cell malignant lymphomas: A BSBMT and ABMTRR study. Bone Marrow Transplant. 40:443–450. 2007. View Article : Google Scholar : PubMed/NCBI
7.	Moskowitz AJ, Lunning MA and Horwitz SM: How I treat the peripheral T-cell lymphomas. Blood. 123:2636–2644. 2014. View Article : Google Scholar : PubMed/NCBI
8.	Savage KJ, Chhanabhai M, Gascoyne RD and Connors JM: Characterization of peripheral T-cell lymphomas in a single North American institution by the WHO classification. Ann Oncol. 15:1467–1475. 2004. View Article : Google Scholar : PubMed/NCBI
9.	Escalón MP, Liu NS, Yang Y, Hess M, Walker PL, Smith TL and Dang NH: Prognostic factors and treatment of patients with T-cell non-Hodgkin lymphoma: The M. D. Anderson Cancer Center experience. Cancer. 103:2091–2098. 2005. View Article : Google Scholar : PubMed/NCBI
10.	Barbarotta L and Hurley K: Romidepsin for the treatment of peripheral T-cell lymphoma. J Adv Pract Oncol. 6:22–36. 2015.PubMed/NCBI
11.	Bekkenk MW, Vermeer MH, Jansen PM, van Marion AM, Canninga-van Dijk MR, Kluin PM, Geerts ML, Meijer CJ and Willemze R: Peripheral T-cell lymphomas unspecified presenting in the skin: Analysis of prognostic factors in a group of 82 patients. Blood. 102:2213–2219. 2003. View Article : Google Scholar : PubMed/NCBI
12.	Lee HJ, Im JG, Goo JM, Kim KW, Choi BI, Chang KH, Han JK and Han MH: Peripheral T-cell lymphoma: Spectrum of imaging findings with clinical and pathologic features. Radiographics. 23:7–26. 2003. View Article : Google Scholar : PubMed/NCBI
13.	Salazar AJ, Aguirre DA, Ocampo J, Camacho JC and Díaz XA: Evaluation of three pneumothorax size quantification methods on digitized chest X-ray films using medical-grade grayscale and consumer-grade color displays. J Digit Imaging. 27:280–286. 2014. View Article : Google Scholar : PubMed/NCBI
14.	Luh SP: Review: Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B. 11:735–744. 2010. View Article : Google Scholar : PubMed/NCBI
15.	Noppen M and de Keukeleire T: Pneumothorax. Respiration. 76:121–127. 2008. View Article : Google Scholar : PubMed/NCBI
16.	Sahn SA and Heffner JE: Spontaneous pneumothorax. N Engl J Med. 342:868–874. 2000. View Article : Google Scholar : PubMed/NCBI
17.	Hobbs BD, Foreman MG, Bowler R, Jacobson F, Make BJ, Castaldi PJ, San José, Estépar R, Silverman EK and Hersh CP: COPDGene Investigators: Pneumothorax risk factors in smokers with and without chronic obstructive pulmonary disease. Ann Am Thorac Soc. 11:1387–1394. 2014. View Article : Google Scholar : PubMed/NCBI
18.	Schmidt-Horlohé N, Rudig L, Azvedo CT and Habekost M: Fulminant unilateral pulmonary edema after insertion of a chest tube: A complication after a primary spontaneous pneumothorax. Dtsch Arztebl Int. 105:878–881. 2008.PubMed/NCBI
19.	Matano S, Satoh S, Sugiguchi S and Sugimoto T: Pneumothorax associated with malignant lymphoma. Intern Med. 49:2337–2339. 2010. View Article : Google Scholar : PubMed/NCBI
20.	Parissis H: Forty years literature review of primary lung lymphoma. J Cardiothoracic Surg. 6:232011. View Article : Google Scholar
21.	Cadranel J, Wislez M and Antoine M: Primary pulmonary lymphoma. Eur Respir J. 20:750–762. 2002. View Article : Google Scholar : PubMed/NCBI
22.	Niu X, Hu H, Gao J, Nie Y, Zhao W, Xu H, Bai X and Chen L: A clinical analysis of 40 cases of primary and secondary pulmonary lymphoma. Zhonghua Jie He He Hu Xi Za Zhi. 37:502–506. 2014.(In Chinese). PubMed/NCBI
23.	Zhu L and Zhang J: Pulmonary malignant lymphoma: A clinicopathological analysis of 16 cases. J Diagn Pathol. 20:740–743. 2013.
24.	Zhang ZY, Wu XH and Shi YX: CT study of pulmonary lymphoma comparison with X-ray. Clin Med J China. 8:26–28. 2001.
25.	Hare SS, Souza CA, Bain G, Seely JM Frcpc, Gomes MM and Quigley M: The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol. 85:848–864. 2012. View Article : Google Scholar : PubMed/NCBI
26.	Shan Y and Zhou Y: Recent research of pathogenesis and causes of recurrence of primary spontaneous pneumothorax. Surg Res New Technique. 4:52–56. 2015.
27.	Went P, Agostinelli C, Gallamini A, Piccaluga PP, Ascani S, Sabattini E, Bacci F, Falini B, Motta T, Paulli M, et al: Marker expression in peripheral T-cell lymphoma: A proposed clinical-pathologic prognostic score. J Clin Oncol. 24:2472–2479. 2006. View Article : Google Scholar : PubMed/NCBI
28.	Wang XY, Xia GG, Zhang YJ, Zhang B and Zhang PJ: Angioimmunoblastic T-cell lymphoma: A case report and review of literature. Int J Respir 32. 6:91–94. 2012.(In Chinese).
29.	Zhe W, Xie YQ and Zhu J: The advance in diagnosis and treatment of peripheral T-cell lymphoma-unspecified. Chin J Clin Oncol. 33:476–480. 2006.
30.	Morabito F, Gallamini A, Stelitano C, Callea V, Guglielmi C, Neri S, Lazzaro A, Orsucci L, Ilariucci F, Sacchi S, et al: Clinical relevance of immunophenotype in a retrospective comparative study of 297 peripheral T-cell lymphomas, unspecified, and 496 diffuse large B-cell lymphomas: Experience of the Intergruppo Italiano Linformi. Cancer. 101:1601–1608. 2004. View Article : Google Scholar : PubMed/NCBI
31.	Intragumtornchai T, Rotnakkarin P, Sutcharitchan P and Wannagrairoj P: Prognostic significance of the immunophenotype versus the International Prognostic Index in aggressive non-Hodgk'ns lymphoma. Clin Lymphoma. 4:52–55. 2003. View Article : Google Scholar : PubMed/NCBI
32.	Gui L, Shi YK, He XH, Lei YH, Zhang HZ, Han XH, Zhou SY, Liu P, Yang JL, Dong M, et al: High-dose therapy and autologous stem cell transplantation in peripheral T-cell lymphoma: Treatment outcome and prognostic factor analysis. Int J Hematol. 99:69–78. 2014. View Article : Google Scholar : PubMed/NCBI
33.	Hopfinger G, Nösslinger T, Lang A, Linkesch W, Melchardt T, Weiss L, Egle A and Greil R: Lenalidomide in combination with vorinostat and dexamethasone for the treatment of relapsed/refractory peripheral T cell lymphoma (PTCL): Report of a phase I/II trial. Ann Hematol. 93:459–462. 2014. View Article : Google Scholar : PubMed/NCBI
34.	Evens AM, Rosen ST, Helenowski I, Kline J, Larsen A, Colvin J, Winter JN, van Besien KM, Gordon LI and Smith SM: A phase I/II trial of bortezomib combined concurrently with gemcitabine for relapsed or refractory DLBCL and peripheral T-cell lymphomas. Br J Haematol. 163:55–61. 2013. View Article : Google Scholar : PubMed/NCBI