SESSION TITLE: Pleural Student/Resident Case Report Posters
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Primary effusion lymphoma (PEL) is one of the subtypes of non-Hodgkin lymphoma, usually presenting as serous effusions without detectable masses or organomegaly. It occurs often in the setting of immunodeficiency and is associated with human immune deficiency virus (HIV), human herpesvirus 8 (HHV8), or Epstein-Barr virus (EBV). The subjects with past asbestos exposure sometimes develop pleural effusion. Malignant pleural mesothelioma (MPM), benign asbestos effusion (BAE), or tuberculous pleuritis are primarily suspected in those cases. We report a case of PEL developed in a subject with past asbestos exposure.
CASE PRESENTATION: A 65-year-old man was referred to our hospital because of dyspnea on exertion. He has smoked a little and was exposed asbestos for 3 years during engaged in the construction industry. A chest X-ray showed left pleural effusion. Computed tomographic images also demonstrated left pleural effusion and plaque with calcification but no irregular pleural thickening. Thoracoscopic exploration demonstrated red-brown pleural effusion and plaque but no pleural tumor was detected in the pleura. Pleural effusion was removed through a drainage tube, and was negative for cytology and culture. Pleural biopsy specimen showed no evidence of malignancy. During the follow up at outpatient department, he showed repeated accumulation of left pleural effusion and thoracentesis was performed each time. On the 4th throcentesis, large atypical lymphocytes with distinct nuclear body and high nucleus to cytoplasm ratio were detected in pleural effusion; those were suspected of malignant lymphoma. Thoracoscopic pleural biopsy was performed again, and the biopsy specimen from the fibrin tissue attached to the pleura demonstrated some groups of small round atypical lymphocytes. Immunohistochemical analyses revealed that the cells were positive for CD20 and negative for CD3, CD5, and CD10. Based on these findings, the diagnosis was confirmed as diffuse large B-cell lymphoma (DLBCL), in fact, PEL.
DISCUSSION: PEL is defined as a unit of disease entity making a part of DLBCL in WHO classification. It occurs often in the setting of immunodeficiency, but there is no previous report of PEL in asbestos-exposed subject. It is unclear the association between PEL and asbestos, but asbestos related inflammation might be associated with the development of PEL in the current case. When we have a patient with lymphocytosis in serous pleural effusion, PEL should be kept in mind in addition to MPM or BAE even in the cases with past asbestos exposure.
CONCLUSIONS: We reported the rare manifestation of PEL in an asbestos-exposed subject.
Reference #1: Fumiaki Kato, Yasutaka Hirasawa, et al. A case of primary effusion lymphoma with elevation of ADA activity in pleural effusion. Nihon Kokyuki Gakkaishi. 2011;49:786-791.
DISCLOSURE: The following authors have nothing to disclose: Naofumi Hara, Nobukazu Fujimoto, Yosuke Miyamoto, Michiko Asano, Yasuko Fuchimoto, Kenichi Kitamura, Shinji Ozaki, Takumi Kishimoto
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