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A 62-year-old man with chronic pyothorax.
Christoph Loddenkemper1, Stefan Hoecht, Ioannis Anagnostopoulos
1Department of Pathology, Consultation and Reference Centre for Lymph Node Pathology and Haematopathology, Berlin, Germany.
Brain Pathology (Zurich, Switzerland)
|January 5, 2006
Summary
Pyothorax-associated lymphoma (PAL) is a rare B-cell non-Hodgkin lymphoma. This case highlights the first diagnosis of PAL in the brain, emphasizing its potential for central nervous system involvement.
Area of Science:
- Oncology
- Neurology
- Pathology
Background:
- Pyothorax-associated lymphoma (PAL) is a rare B-cell non-Hodgkin lymphoma (B-NHL) linked to chronic pyothorax.
- PAL typically arises in the pleural cavity after a prolonged history of infection.
Observation:
- A 62-year-old man with a history of chronic pyothorax presented with progressive ataxia.
- Cerebellar vermis lesion identified via MRI, with biopsy revealing an immunoblastic lymphoma.
Findings:
- Immunohistochemistry showed an aberrant dual B/T phenotype and Epstein-Barr virus (EBV) type III latency.
- In-situ hybridization confirmed EBV-encoded RNAs in tumor cells.
- PCR analysis detected clonal B-cells in the brain lesion and a mediastinal tumor.
Implications:
- Central nervous system (CNS) involvement in PAL is rare but significant, observed in 14% of autopsy cases.
- This case represents the first documented instance of PAL initially diagnosed via a brain biopsy.
- Highlights the importance of considering PAL in patients with a history of chronic pyothorax and neurological symptoms.