title: Pericardial effusion: a rare presentation of adult T-cell leukemia/lymphoma.
abstract: Adult T-cell leukemia/lymphoma (ATLL) has a wide variety of clinical presentations. The most common ones include leukemia, hypercalcemia, lymphadenopathy, hepatosplenomegaly, and skin lesions. We report a case of ATLL in a 73-year-old woman who presented initially with chest discomfort and shortness of breath. The patient had no peripheral lymphadenopathy, circulating lymphoma cells, hepatosplenomegaly, or skin lesions. CT scan showed small mediastinal lymph nodes and pericardial effusion. Diagnosis was established by cytomorphologic evaluation and flow cytometric analysis of the pericardial fluid. Cardiac involvement is a rare event in ATLL and, when present, usually is a late finding in the setting of disseminated disease. This case was unusual because the patient lacked all common clinical features of ATLL. We present this case so as to increase awareness that ATLL could initially present with pericardial effusion. The pathophysiologic mechanisms of cardiac involvement are also discussed.
authors.affiliation: Boston Medical Center, Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA. fernando.chaves@bmc.org
authors.forename: Fernando P
authors.initials: FP
authors.lastname: Chaves
authors.forename: Karen
authors.initials: K
authors.lastname: Quillen
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Xu
mesh_terms: D000368:Aged; D001826:Body Fluids / Q000166:cytology; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D015458:Leukemia, T-Cell / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed