Neuropathy associated with angioimmunoblastic lymphadenopathy-like T-cell lymphoma

Area of Science:

• Oncology
• Neurology
• Immunology

Background:

• Angioimmunoblastic lymphadenopathy-like T cell lymphoma (AITL) is a distinct subtype of peripheral T cell lymphoma.
• Polyneuropathy can be a paraneoplastic or direct manifestation of lymphoid malignancies.

Observation:

• A 75-year-old woman presented with peripheral neuropathy, lymphadenopathy, and fever.
• Immunohistochemical and electrophysiological studies confirmed angioimmunoblastic lymphadenopathy-like T cell lymphoma with polyneuropathy.
• Lymphoma cells infiltrated the sural nerve and lymph nodes, expressing CD45RO, CD3, and CD30.
• Endothelial and Schwann cells showed increased HLA-DR antigen expression.

Findings:

• The study identified direct lymphocytic infiltration of the sural nerve by lymphoma cells.
• Shared immunophenotype (CD45RO, CD3, CD30 positive) was observed in both lymph node and sural nerve lymphoma cells.
• Increased HLA-DR expression in endothelial and Schwann cells suggests an inflammatory or reactive process.

Implications:

• Direct nerve infiltration by lymphoma cells is a potential mechanism for polyneuropathy in AITL.
• Chemotherapy (CHOP-Bleomycin) effectively alleviated neuropathic pain, supporting a direct link between lymphoma and neuropathy.
• This case highlights the importance of considering lymphoma in the differential diagnosis of unexplained polyneuropathy.