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Published on: August 14, 2017
Rapidly progressive Lennert's lymphoma terminating in fulminant hepatic failure
Hiroshi Kojima1, Seiichi Shimizu, Chikashi Yoshida
1Division of Hematology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan. hkojima@md.tsukuba.ac.jp
Insights
Lennert's lymphoma, a type of cytotoxic T-cell lymphoma, can present with aggressive symptoms and rapid liver failure. Conventional chemotherapy may not be effective against this aggressive lymphoma variant.
Area of Science:
- Oncology
- Hematology
- Immunology
Background:
- Lennert's lymphoma is a rare non-Hodgkin lymphoma.
- Cytotoxic T-cell lymphomas are aggressive lymphoid malignancies.
Observation:
- A 65-year-old male presented with rapidly progressive Lennert's lymphoma.
- Radiological studies showed lymphadenopathy and splenic lesions.
- Lymph node biopsy revealed epithelioid cells and atypical lymphocytes.
Findings:
- Immunophenotyping indicated a cytotoxic T-cell lineage (CD3+, CD8+, granzyme B+, perforin+).
- Despite CHOP chemotherapy, the patient developed liver failure and disseminated intravascular coagulation.
- Liver biopsy confirmed lymphoma cells with a CD8+ cytotoxic phenotype.
Implications:
- This case supports the hypothesis that some Lennert's lymphomas are cytotoxic T-cell lymphomas.
- Lennert's lymphomas expressing cytotoxic proteins may exhibit a fulminant clinical course.
- Conventional chemotherapy may be insufficient for managing these aggressive T-cell lymphomas.
Abstract:
A 65-year-old male with rapidly progressive Lennert's lymphoma terminating in fulminant hepatic failure is presented. Staging radiological studies revealed that he had cervical and mediastinal lymph node swellings and multiple nodular lesions in the spleen. Lymph node biopsy specimens showed the proliferation of epithelioid cells interspersed with large blastic lymphocytes. These lymphocytes were CD3+, CD45RO (UCHL-1) +, CD4-, CD8+, CD56-, CD30-, CD15-, T-cell intracellular antigen-1+, granzyme B+ and perforin+, suggestive of the cytotoxic T-cell lineage. Under the diagnosis of Lennert's lymphoma, he was treated with standard CHOP chemotherapy. After two courses of the chemotherapy, despite the decreased size of cervical lymph nodes, high-grade fever and constitutional symptoms appeared. As multiple low-density nodules were observed in the liver by computed tomography, needle biopsy was performed. The biopsy specimens showed the proliferation of CD3+, CD4- and CD8+ lymphoma cells. Thereafter, the liver function deteriorated rapidly, and disseminated intravascular coagulation emerged. He died of rapidly progressive hepatic failure. This case is another example demonstrating that at least some of the Lennert's lymphomas phenotypically correspond with cytotoxic T-cell lymphomas, as was previously suggested by us [Am. J. Surg. Pathol. 24 (2000) 1627]. It should be also emphasized that Lennert's lymphomas containing cytotoxic proteins may have a fulminant clinical course, which cannot be rescued by the conventional chemotherapy.
