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Published on: May 23, 2015
A case report of extranodal NK/T cell lymphoma nasal-type with direct pulmonary involvement
Hui Zhang1, Jiaming Yin2, Haibo Ge1
1Pulmonary and Critical Care Medicine, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
Rationale:
Extranodal nasal-type NK/T-cell lymphoma primarily invades the nasal and nasopharyngeal regions, while direct pulmonary involvement is extremely rare and prone to clinical misdiagnosis or oversight.
Patient Concerns:
A 45-year-old man presented with recurrent high fever and cough. Anti-infective therapy and the peaspartase + methotrexate + etoposide + dexamethasone regimen proved ineffective, with chest CT demonstrating disease progression.
Diagnoses:
A patient with extranodal nasal-type NK/T-cell lymphoma, classified as stage IV group B refractory category, predominantly presenting with lung infiltration and concurrent multiorgan involvement of the bone marrow and adrenal glands is described herein.
Interventions:
The disease was controlled only after timely adjustment to a gemcitabine combined with oxaliplatin + PD-1 inhibitor chemotherapy regimen.
Outcomes:
The patient now remains clinically stable with adequate oral intake and satisfactory sleep quality.
Lessons:
Clinicians should broaden diagnostic considerations and pay greater attention to heterogeneous tumors. For patients presenting with persistent recurrent fever, pulmonary consolidation lesions, and poor response to anti-infective therapy, prompt percutaneous lung biopsy should be performed to obtain pathological confirmation.
Insights
Extranodal nasal-type NK/T-cell lymphoma rarely affects the lungs. Prompt lung biopsy is crucial for diagnosing this rare pulmonary manifestation, especially when initial treatments fail.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Extranodal nasal-type NK/T-cell lymphoma typically affects the nasal cavity.
- Pulmonary involvement is rare and often misdiagnosed.
Purpose of the Study:
- To report a rare case of extranodal NK/T-cell lymphoma with predominant lung infiltration.
- To highlight the diagnostic challenges and effective treatment strategies for this condition.
Main Methods:
- Case report of a 45-year-old male with refractory lymphoma.
- Initial treatment with anti-infectives and a chemotherapy regimen (peASPARTASE + methotrexate + etoposide + dexamethasone) was ineffective.
- Diagnosis confirmed via percutaneous lung biopsy.
- Treatment adjusted to gemcitabine, oxaliplatin, and PD-1 inhibitor therapy.
Main Results:
- The patient presented with recurrent fever and cough, initially unresponsive to treatment.
- Chest CT showed disease progression with lung infiltration, bone marrow, and adrenal gland involvement.
- The adjusted chemotherapy regimen led to disease control.
Conclusions:
- Pulmonary involvement in NK/T-cell lymphoma is rare but should be considered in patients with persistent fever and pulmonary lesions unresponsive to antibiotics.
- Early diagnosis via lung biopsy is critical.
- Combination chemotherapy including gemcitabine, oxaliplatin, and PD-1 inhibitors can be effective for refractory disease.
