대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1007 Date 2017-02-13

  • Courtesy of Bo Mi Gil, MD, Myung Hee Chung, MD / Bucheon St. Mary’s Hospital, The Catholic Unversity of Korea
  • Age/Sex 68 / M
  • Chief ComplaintFever, dyspnea, eosinophilia 50%
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Angioimmunoblastic T cell lymphoma
Radiologic Findings

Figs 1 & 2. Contrast-enhanced CT scans show bilateral peribronchial, particularly left interlobar and left lower lobar, lymphadenopathy.
Fig 3 & 4. Lung window setting images show extensive peribronchial conslidations and surrounding GGO, superimposed on centrilobular emphysema in the whole lung fields
Brief Review
Angioimmunoblastic T cell lymphoma (AIBTL) was confirmed by bone marrow and lymph node biopsies. Transbronchial lung biopsy showed interstitial fibrosis with irregular septal wall thickening and chronic inflammatory cell and partial lymphomatous cell infiltrations. Eosinophilia is one complication of lymphoproliferative disorders that is rarely observed and sometimes the first manifestation of lymphoma. Absolute eosinophilia in the peripheral blood of patients with AIBTL was observed in 13 of 65 patients (21%) (1). Although the exact mechanism for the development of eosinophilia associated with lymphoma remains unclear, one possibility is due to the secretion of lymphokines by the transformed lymphocytes. When T-lymphocytes are stimulated and activated by antigens or mitogens, they begin to produce various lymphokines. Currently, three lymphokines (granulocyte/macrophage colony-stimulating factor, IL-3, and IL-5) are known to induce eosinophilia. Angioimmunoblastic T-cell lymphoma is most commonly associated with increased reactive eosinophilopoiesis (2).
References
1. Murata FK, Yamada Y, Kamihira S, et al. Frequency of eosinophilia in adult T-cell leukemia/ymphoma. CANCER 1992;69(4):966-971
2. Roufosse F, Garaud S, de Leval L. Lymphoproliferative disorders associated with hypereosinophilia. Semin.Hematol. 2012;49(2):138-148
Keywords
Lung, Lymph node,

No. of Applicants : 101

▶ Correct Answer : 8/101,  7.9%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - , Korea (South) JUYEON LEE
  • - Asan Medical Center , Korea (South) JOO YEON LEE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Toshiba Hospital , Japan RYO KUROKAWA
  • - DECRH, Fredericton , Canada RAM P GALWA
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
▶ Correct Answer as Differential Diagnosis : 32/101,  31.7%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - the First Affiliated Hospital of NanJing Medical University , China AIPING CHEN
  • - Chonnam National University Hwasun Hospital , Korea (South) INSOO JANG
  • - Myongji Hospital , Korea (South) KYUNGHO KIM
  • - Other , Korea (South) HEE SEOK CHOI
  • - Other , Korea (South) SEONG SU KANG
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Chonbuk National University Hospital , Korea (South) GUNSU KIM
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Asan Medical Center , Korea (South) JIHYE KWON
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Kyeongpook National University Hospital , Korea (South) SUNGJUN MOON
  • - Samsung Medical Center , Korea (South) BODA NAM
  • - , Korea (South) HYERIN KIM
  • - GHICL , France MANUEL TOLEDANO
  • - Kanto Rosai Hospital , Japan TAKU TAJIMA
  • - , Australia RASHID HASHMI
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - , Korea (South) JINWOO HAN
  • - Ajou University Hospital , Korea (South) SEULGI YOU
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Private sector , Greece VASILIOS TZILAS
  • - Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
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