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Weekly Chest CasesArchive of Old Cases

Case No : 1260 Date 2021-12-13

  • Courtesy of Hyun-ju Lim, Kun Young Lim, Soo-Hyun Lee, Hyae Young Kim / National Cancer Center
  • Age/Sex 54 / M
  • Chief ComplaintP/Hx: Mycosis fungoides patient Chief complaint of fever
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pulmonary involvement of cutaneous T cell lymphoma
Radiologic Findings
Fig 1. Chest PA shows multiple nodular opacities in both lungs.
Fig 2-4. CT scan reveals multiple nodules with or without peripheral ground-glass opacity in both lungs.
Brief Review
Wedge resection of the right upper lobe was performed in the current patient. Malignant lymphoma of T-cell lineage was pathologically diagnosed.
Cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of lymphoproliferative disorders that are characterized by the location of malignant T-lymphocytes in the skin at presentation. The classic subsets of this disease are mycosis fungoides and Sezary syndrome. Patients’ immunocompromised status leads to death from opportunistic infection or sepsis. In its later stages, mycosis fungoides can cause peripheral lymphadenopathy and may progress to widespread extra cutaneous visceral involvement. The lungs are among the most common sites of visceral involvement and its incidence is less than 1% of all patients with CTCL.
Patients with lung involvement of CTCL have few respiratory symptoms and presented with nodular disease on chest radiograph that progressed over time.
The radiologic manifestation of pulmonary involvement of CTCL includes peribronchovascular nodules with surrounding ground-glass opacities, multiple bilateral parenchymal nodular densities, patchy areas of consolidation, bilateral pulmonary infiltrates, interstitial infiltrations with or without hilar lymphadenopathy, and pleural effusion without underlying parenchymal disease.
References
Baser S, Onn A, Lin E, Morice R and Duvic M. Pulmonary manifestations in patients with cutaneous T-cell lymphomas. Cancer. 2007 Apr 15;109(8):1550-1555
Keywords

No. of Applicants : 89

▶ Correct Answer : 32/89,  36.0%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Korea University Guro Hospital , Korea (South) SEOKYOUNG LEE
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - , United Kingdom SAMSON KADE
  • - CHCB , France LE GUEN RAPHAEL
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - Chungbuk National University Hospital , Korea (South) HOSIG JANG
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Japanese Red Cross Medical Center , Japan YASUSHI AOYAGI
  • - SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES, WHITEFIELD , India SHAIK ISMAIL
  • - Other , Korea (South) JOO HEE KIM
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - , Korea (South) YEONG UK HWANG
  • - , United States HIROAKI TAKAHASHI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Other , Korea (South) SEONG WON JANG
  • - Chungbuk National University Hospital , Korea (South) PARK JUN HYEON
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - , Japan SOTA MASUOKA
  • - , Japan KANA TANAKA
  • - , Japan KAZUMA TERAUCHI
  • - , Japan YUMI MAEHARA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 27/89,  30.3%
  • - , Japan HIROAKI ARAKAWA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Other , Korea (South) HYEJIN YANG
  • - Other , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Italy PAOLO BALDASSARI
  • - Manipal HealthMap , India SHASHANK SOOD
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Osaka University , Japan AKINORI HATA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) HYEWON CHOI
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Korea University Guro Hospital , Korea (South) YOON CHUL LEE
  • - , Korea (South) EUNJIN LEE
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Other , Korea (South) MINSU KIM
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Korea (South) WONJU HONG
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 7/89,  7.9%
  • - , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - , China WANG DR
  • - , Japan YUKI HAYASHI
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