title: Rapidly progressive Lennert's lymphoma terminating in fulminant hepatic failure.
abstract: A 65-year-old male with rapidly progressive Lennert's lymphoma terminating in fulminant hepatic failure is presented. Staging radiological studies revealed that he had cervical and mediastinal lymph node swellings and multiple nodular lesions in the spleen. Lymph node biopsy specimens showed the proliferation of epithelioid cells interspersed with large blastic lymphocytes. These lymphocytes were CD3+, CD45RO (UCHL-1) +, CD4-, CD8+, CD56-, CD30-, CD15-, T-cell intracellular antigen-1+, granzyme B+ and perforin+, suggestive of the cytotoxic T-cell lineage. Under the diagnosis of Lennert's lymphoma, he was treated with standard CHOP chemotherapy. After two courses of the chemotherapy, despite the decreased size of cervical lymph nodes, high-grade fever and constitutional symptoms appeared. As multiple low-density nodules were observed in the liver by computed tomography, needle biopsy was performed. The biopsy specimens showed the proliferation of CD3+, CD4- and CD8+ lymphoma cells. Thereafter, the liver function deteriorated rapidly, and disseminated intravascular coagulation emerged. He died of rapidly progressive hepatic failure. This case is another example demonstrating that at least some of the Lennert's lymphomas phenotypically correspond with cytotoxic T-cell lymphomas, as was previously suggested by us [Am. J. Surg. Pathol. 24 (2000) 1627]. It should be also emphasized that Lennert's lymphomas containing cytotoxic proteins may have a fulminant clinical course, which cannot be rescued by the conventional chemotherapy.
authors.affiliation: Division of Hematology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan. hkojima@md.tsukuba.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kojima
authors.forename: Seiichi
authors.initials: S
authors.lastname: Shimizu
authors.forename: Chikashi
authors.initials: C
authors.lastname: Yoshida
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Katsura
authors.forename: Kazumi
authors.initials: K
authors.lastname: Suzukawa
authors.forename: Harumi Y
authors.initials: HY
authors.lastname: Mukai
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hasgawa
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Imagawa
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Mori
authors.forename: Toshiro
authors.initials: T
authors.lastname: Nagasawa
mesh_terms: D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019070:Cell Lineage; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D017093:Liver Failure / Q000209:etiology*; D008113:Liver Neoplasms / Q000473:pathology; D008198:Lymph Nodes / Q000276:immunology / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D013602:T-Lymphocytes, Cytotoxic / Q000473:pathology; D017211:Treatment Failure
chemical_list: D015703:Antigens, CD