Diagnostic utility of medical thoracoscopy in T cell lymphoblastic lymphoma presenting with pleural effusion

Abstract

Adult lymphoblastic lymphoma (LBL) is an aggressive form of non-Hodgkin lymphoma occurring among predominantly adolescent and young adult men, accounting for 1%-2% of all non-Hodgkin's lymphomas. In contrast to B-LBL, T-cell LBL is much more common, accounting for up to 90% of disease in adults. Mediastinal mass, pleural and/or pericardial effusions are the major characteristics of T-LBL. We report an 27-year-old male with a pleural effusion, mediastinal lymphadenitis, and a normal hemogram. The cytology of the pleural effusion initially was lymphocytic exudative and ADA was high. For definitive diagnosis a medical thoracoscopy was done. The partial pleura showed multiple irregular nodules and thickening in sheets. It was picked and immunophenotypic study revealed the following: CD3, TdTþ, CD7 with Ki 67 index of 70-80%. The patient was finally diagnosed with T-LBL. He was treated with chemotherapy and is on regular follow up with resolution of effusion. The case highlight the point that medical thoracoscopy is a safe and accurate diagnostic procedure for pleural diseases, and partial pleura biopsy yielded the correct diagnosis.

Keywords: Diagnostic utility of medical thoracoscopy in T cell lymphoblastic lymphoma presenting with pleural effusion.

Fig. 1

Chest radiograph showing right pleural effusion with a light contralateral shift of the trachea and mediastinum.

Fig. 2

CT chest showing right sided moderate pleural effusion with multiple enlarge mediastinal lymphnodes.

Fig. 3

Ultrasonography image showing effusion with underlying collapsed lung with airbronchogram and visceral pleural nodule.

Fig. 4

Thoracoscopy image showing linear thickening of parietal pleura along with the rib margin.

Fig. 5

Hispathological examination of the arietal pleural biopsies after medical Thoracoscopy showing parietal pleura infiltrated by monotonous small lymphoid cells with scanty cytoplasm and slightly irregular, round oval nuclei, and dense chromatin (hematoxylin and eosin staining, original magnification ×400).