Peripheral T-cell lymphoma-unspecified (PTCL-U) presenting with hypereosinophilic syndrome and pleural effusions

Abstract

Hypereosinophilic syndrome (HES) is a clinical disorder characterized by persistent eosinophilia and systemic involvement, in which a specific causative factor for the eosinophilia cannot be verified during a certain period of time. There have been only a few reported cases of this syndrome associated with malignant lymphoma. We report a case of peripheral T-cell lymphoma-unspecified with hypereosinophilic syndrome. The patient was a 42-year-old woman with an uncontrolled fever and a sore throat. Eosinophilia was observed on the peripheral blood smear. We confirmed the diagnosis by bone marrow and liver biopsies:. A bone marrow aspiration demonstrated markedly increased eosinophils (24.8%), and a liver biopsy demonstrated infiltration by scattered eosinophils and atypical lymphoid cells, which were confirmed to be T-cell lymphoma cells. This case was a distinctive presentation of peripheral T-cell lymphoma with hypereosinophilic syndrome, probably due to a paraneoplastic condition.

Figure 1

(A) A chest X-ray demonstrated mild pulmonary congestion and a left pleural effusion. (B) A chest CT demonstrated mild pulmonary congestion and bilateral pleural effusions (arrow).

Figure 2

Abdominal CT. (A) Demonstrated diffuse hepatosplenomegaly. (B) Demonstrated left paraaortic lymphadenopathy (arrow).

Figure 3

Bone marrow aspiration demonstrated a markedly increased number of eosinophils (Giemsa stain, ×1000) (arrow).

Figure 4

Pleural fluid cytology. (A) Demonstrated a few atypical cells (papanicolaou smear, ×1000) (arrowhead). (B) Demonstrated a few atypical cells (Ki 67 stain, ×1000) (arrowhead).

Figure 5

Liver biopsy. (A) Demonstrated a few atypical lymphoid cells (arrowhead) and eosinophils (H & E stain, ×400) (arrow) in the portal space. (B) Demonstrated eosinophils (Ki 67 stain, ×1000) (arrow) in the portal space. (C) Demonstrated eosinophils (CD3 stain, ×1000) (arrow) in the portal space (CD3 stain, ×1000).

Figure 6

Abdominal CT demonstrated marked improvement in the lymphadenopathy after 6 courses of chemotherapy.

Figure 7

Abdominal CT demonstrated an increase in the size and extent of the lymphadenopathy (arrow), one month after completion of the eighth course of chemotherapy.