T-cell lymphoma with a granulomatous lesion of the lungs after autologous hematopoietic stem cell transplantation for Epstein–Barr virus-positive diffuse large B-cell lymphoma: a unique rare case of metachronous B-cell and T-cell lymphoma

Diagnostic Pathology

Akira Shimizu¹  Mika Terasaki¹  Shinobu Kunugi¹  Yugo Okabe¹  Yusuke Kajimoto¹  Yasuhiro Terasaki²  Satoshi Wakita³  Koiti Inokuchi³ 

[1] Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, 113-0031, Tokyo, Japan;Department of Analytic Human Pathology, Nippon Medical School, 1-25-16, Nezu, Bunkyo-ku, 113-0031, Tokyo, Japan;Division of Pathology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, 113-8602, Tokyo, Japan;Department of Hematology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, 113-8602, Tokyo, Japan;

关键词: Epstein–Barr virus;    Primary immunodeficiency disorder;    Common variable immunodeficiency;    Peripheral T-cell lymphoma;    Diffuse large B-cell lymphoma;    Post-transplant lymphoproliferative disorder;    Autologous hematopoietic stem cell transplantation;    Granuloma;   

DOI  :  10.1186/s13000-020-01038-3

来源: Springer

【 摘 要 】

BackgroundEpstein–Barr virus (EBV) is associated with the pathogenesis of a variety of malignancies, most notably lymphomas. Especially in the background of immunodeficiency, such as primary immunodeficiency disorder (PID) and post-transplant lymphoproliferative disorder (PTLD), the role of EBV might be crucial. PIDs are rare heterogeneous diseases affecting the development and/or the function of the innate and adaptive immune system. Malignancy is the second-highest cause of death after infection, and lymphoma accounts for about half of malignancies. The most frequently reported lymphoma type is diffuse large B-cell lymphoma (DLBCL) and the incidence of T-cell lymphoma is rare. PTLDs are also rare serious lymphoid and/or plasmacytic proliferative disorders that occur after undergoing solid organ or hematopoietic stem cell transplantation (HSCT). In the context of HSCT, most reported PTLDs have occurred in patients who received allogenic HSCT, but only a few cases have been reported in autologous HSCT (AutoHSCT) recipients.Case presentationA 53-year-old female patient initially presented with enlargement of the left cervical lymph nodes and was diagnosed with EBV-positive DLBCL. She was treated with R-CHOP, R-ACES, and AutoHSCT and went into remission. Four years later, computed tomography results revealed multiple lung nodules and abnormal infiltration, and sustained and progressing hypogammaglobulinemia was observed. The pathological specimen of video-assisted thoracoscopic surgical lung biopsy demonstrated extensive invasion of lymphocytes with notable granuloma findings. Flow cytometric immunophenotyping analysis showed that lymphocytes were positive for CD3 and CD5; especially, CD3 was expressed in the cytoplasm. Southern blot analysis revealed rearrangements of the T-cell receptor Cβ1 gene. She was diagnosed with peripheral T-cell lymphoma, not otherwise specified, accompanied by notable granulomatous lesions.ConclusionHere, as a unique case of metachronous B-cell and T-cell lymphoma, we report a rare case of T-cell lymphoma that mainly affected the lungs with the presentation of notable granulomatous findings following AutoHSCT for EBV-positive DLBCL at the age of 53 years. These lung lesions of granulomatous T-cell lymphoma could be related to the underlying primary immunodeficiency background associated with sustained hypogammaglobulinemia.

【 授权许可】

CC BY