[A case of CD56 positive T-cell lymphoma originating from mediastinal lymph nodes].
The patient, a 63-year-old man was admitted to our hospital with complaints of high-grade fever and left chest pain. The chest X-ray film taken on admission showed the presence of pleural effusion. The chest CT scan revealed left mediastinal enlargement. Examination of the pleural effusion showed a high concentration of adenosine deaminase (ADA) and the cytological examination showed no malignancy. We diagnosed pleuritis tuberculosa. His general condition worsened in spite of anti-tuberculosis therapy and soluble interleukin-2 receptor (sIL-2R) was elevated. The video-assisted thoracoscopic biopsy was negative. Soon after that the lymph nodes from the left supraclavicular region to the mediastinum became swollen. The diagnosis of peripheral T-cell lymphoma, unspecified (WHO classification) with CD56 expression, was established based on the results of lymph node biopsy and pleural effusion cytology. He was treated with cyclophosphamide/doxorubicin/vincristine/prednisolone (CHOP) chemotherapy. Since two courses of chemotherapy were not effective we changed to carboplatin/ifosfamide/ etoposide/dexamethasone (DeVIC) chemotherapy. His condition improved and a complete response was obtained. In conclusion, the presence of a high level of ADA in the pleural effusion and resistance to anti-tuberculosis therapy should suggest a malignant lymphoma.
Tanigawa
Motoaki
M
Division of Respiratory Diseases, Department of Medicine, Yamada Red Cross Hospital.
Ishiga
Takeshi
T
Ichioka
Maresuke
M
Saito
Kimimasa
K
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D019002:CD56 Antigen / Q000032:analysis*; D016190:Carboplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008198:Lymph Nodes / Q000473:pathology*; D016399:Lymphoma, T-Cell / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000175:diagnosis; D011239:Prednisolone / Q000008:administration & dosage; D014396:Tuberculosis, Pleural / Q000175:diagnosis; D014750:Vincristine / Q000008:administration & dosage
D019002:CD56 Antigen; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D016190:Carboplatin; D007069:Ifosfamide