Two Atypical Clinical Cases of a Rare Lymphoma: Peripheral T-Cell Lymphoma

Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of uncommon and frequently severe lymphomas. There are around 30 different subtypes, with peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma having the poorest outcomes under standard chemotherapy. We discuss two cases with unusual initial presentations of these aggressive subtypes of peripheral T-cell lymphoma. The first case is a peripheral T-cell lymphoma, not otherwise specified, which initially presents with pain in the left hip. For six months, this pain was erroneously labeled as degenerative osteoarticular pathology. When exploring further the patient's symptoms, one can see a set of constitutional symptoms that accompany the pain and end up sounding alarm bells. Imaging examinations reveal a lytic bone lesion in the iliac crest and multiple adenopathy formations. The bone lesion biopsy provides a definitive diagnosis, and after six cycles of chemotherapy, the control examinations reveal a complete remission. The second case is a nodal T-follicular helper lymphoma, angioimmunoblastic subtype, that initially appeared to be a respiratory infection that did not respond to antibiotic therapy. However, by carefully reviewing the anamnesis, it was possible to identify constitutional symptoms that should have alerted to a different diagnosis. Imaging examinations confirmed the suspicion and reported numerous adenopathies as well as splenomegaly associated with splenic infarction. Axillary adenopathy biopsy dictated the diagnosis. The patient completed six cycles of chemotherapy with a complete response. These cases demonstrate how crucial it is to keep an elevated level of suspicion for this uncommon pathology to avoid delays in diagnosis and thereby maximize the chance of a successful outcome.