J Korean Med Sci.  2017 Oct;32(10):1727-1730. 10.3346/jkms.2017.32.10.1727.

Primary Pulmonary Extranodal Natural Killer/T-cell Lymphoma, Nasal Type Presenting as Diffuse Ground Glass Opacities: a Case Report

Affiliations
  • 1Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea. dobie@yuhs.ac
  • 2Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTCL) is a rare type of lymphoma that accounts for only 5%-18% of all cases of non-Hodgkin lymphoma (NHL). In published series, 60%-90% of NK/T-cell lymphomas are localized to the nasal and upper airway. We describe a 55-year man who presented with cough, sputum, dyspnea on exertion, and a chest computed tomography scan shows diffuse ground glass opacities (GGOs), suggestive of an interstitial lung disease. He was treated with a corticosteroid and his symptoms improved. However, when the corticosteroid was tapered, his symptoms recurred. The patient underwent a surgical lung biopsy and ENKTCL was diagnosed. We present this case because ENKTCL involving only the lung is very rare but very informative. To our knowledge, our patient is the first case that primary pulmonary ENKTCL is presented with GGOs.

Keyword

Lymphoma, Extranodal NK-T-Cell; Lung Involvement; Lung Diseases, Interstitial; Ground Glass Opacities

MeSH Terms

Biopsy
Cough
Dyspnea
Glass*
Humans
Lung
Lung Diseases, Interstitial
Lymphoma*
Lymphoma, Extranodal NK-T-Cell
Lymphoma, Non-Hodgkin
Sputum
Thorax

Figure

  • Fig. 1 Follow-up CT scan shows diffuse GGOs at both lungs with underlying emphysema. Arrows indicate sites of wedge resections. Posterior basal segment of right lower lobe (A) and lateral segment of right middle lobe (B). (A, B) Axial view. (C) Coronal view. CT = computed tomography, GGOs = ground glass opacities.

  • Fig. 2 Histopathology of the lung biopsy. (A) Angiocentric infiltration of the lung parenchyme (magnification × 200). (B) Neoplastic cells stained for granzyme B (magnification × 200). (C) Neoplastic cells stained for CD2 (magnification × 200). (D) Neoplastic cells with loss of expression for surface CD3 (magnification × 200). (E) EBERs by in situ hybridization (magnification × 100). EBERs = Epstein-Barr virus encoded small nuclear RNAs.

  • Fig. 3 PET-CT scan shows no significant FDG uptake to suggest malignancy. The lung where ENKTCL is confirmed by biopsy also shows no FDG uptake. PET-CT = positron emission tomography-computed tomography, FDG = fluorodeoxyglucose, ENKTCL = extranodal natural killer/T-cell lymphoma, nasal type.


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