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Case Reports
. 2023 Jun 15;62(12):1807-1811.
doi: 10.2169/internalmedicine.9745-22. Epub 2022 Oct 19.

Primary Effusion Lymphoma-like ATL Developing during Hemodialysis

Miharu Masaki  1 , Yuki Okushi  2 , Atsushi Saito  2 , Akihiro Fukuda  3 , Sohsuke Yamada  4 , Shuichi Mizuta  5 , Yasufumi Masaki  5
Affiliations
Case Reports

Primary Effusion Lymphoma-like ATL Developing during Hemodialysis

Miharu Masaki et al. Intern Med. .

Abstract

We herein report a patient with primary effusion lymphoma-like adult T-cell leukemia/lymphoma (PEL-like ATL) that developed during hemodialysis. A 77-year-old man developed a fever and ascites. Elevated levels of lactate dehydrogenase (LDH), calcium and soluble interleukin-2 receptor (sIL-2R) along with antibodies to human T-cell leukemia virus type 1 (HTLV-1) were seen in his blood. Lymphoma cells in ascites were positive for HTLV-1 proviral DNA, but there were no neoplastic cells in peripheral blood or bone marrow and no lymphadenopathy. He was therefore diagnosed with PEL-like ATL, acute-type. After administration of brentuximab vedotin, his serum LDH, sIL-2R and atypical cells in ascites cytology decreased. The development of novel effective molecular-targeted therapies is warranted.

Keywords: ATL; chronic renal failure; primary effusion lymphoma.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Image findings at admission. a, b: Plain CT of the chest to the abdomen, showing a large amount of ascites fluid but no evidence of lymphadenopathy or hepatosplenomegaly. c: 67Gallium scintigraphy showing no evidence of significant abnormal accumulation.
Figure 2.
Figure 2.
Ascites fluid test findings (Day 2). The number of cells in ascites fluid was 16,318 /μL, including 57% neutrophils, 2% lymphocytes, 2% histiocytes, and 39% atypical cells. The concentration of LDH in ascites was 3,685 IU/L. a: May Giemsa staining of cytospin specimens, showing many very large and constricted atypical cells. b-h: Cell block specimen stained with (b) Hematoxylin and Eosin staining and (c-g) antibodies to (c) CD3, (d) CD4, (e) CD8, (f) CD20, and (g) CD30 and subjected to (h) EBER in situ hybridization; immunostaining of cell blocks showed that the atypical large cells were positive for CD4 (d) and CD30 (g), but negative for CD3 (c), CD8 (e), CD20 (f), and EBER in situ hybridization (h). Only normal-sized lymphocytes were positive for CD3 (c) and CD8 (e).
Figure 3.
Figure 3.
Changes in the LDH and sIL-2R values during the course of treatment. *1: soluble interleukin-2 receptor. *2: methylprednisolone. *3: brentuximab vedotin. *4: prednisolone.
See this image and copyright information in PMC

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