title: A 62-year-old man with chronic pyothorax.
abstract: June 2005. Pyothorax-associated lymphoma (PAL) is a rare B-cell non-Hodgkin lymphoma (B-NHL) which develops in the pleural cavity after a 20- to 64-year history of chronic pyothorax. We present here the case of a 62-year-old man who suffered from chronic pyothorax after pneumectomy 44 years ago, and complained of progressive ataxia. A MRI of the head revealed a solitary lesion in the vermis cerebelli, and a biopsy showed a lymphoma displaying immunoblastic features. Immunohistochemistry revealed an aberrant dual B/T phenotype and an Epstein-Barr virus (EBV) type III LMP-1+/EBNA-2+ latency profile. In-situ hybridization disclosed EBV-encoded RNAs in the tumor cells. PCR for the detection of rearranged immunoglobulin heavy chain (IgH) genes followed by GeneScan analysis demonstrated a clonal B-cell population with DNA amplificates of identical size in the brain manifestation, and a large mediastinal tumor analyzed post mortem. Among the largest series of 106 PALs collected through a nationwide survey in Japan, central nervous system (CNS) involvement was detected in 5 (14%) of 36 patients where an autopsy had been performed. To best of our knowledge, this is the first case of a pyothorax-associated lymphoma initially diagnosed on brain biopsy.
authors.affiliation: Department of Pathology, Consultation and Reference Centre for Lymph Node Pathology and Haematopathology, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: Stefan
authors.initials: S
authors.lastname: Hoecht
authors.forename: Ioannis
authors.initials: I
authors.lastname: Anagnostopoulos
authors.forename: Bernhard
authors.initials: B
authors.lastname: Heine
authors.forename: Gisela
authors.initials: G
authors.lastname: Stoltenburg-Didinger
authors.forename: Harald
authors.initials: H
authors.lastname: Stein
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary*; D016724:Empyema, Pleural / Q000150:complications*; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology* / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects