ABSTRACT
Primary effusion lymphoma (PEL) is an exceptionally rare and challenging entity to diagnose, characterized by the development of lymphomatous effusions in body cavities without a solid tumour mass. Here, we present a case of PEL in a 76-year-old retired professor with a complex medical history including diabetes, hypertension, and bilateral total knee replacement surgery. The patient initially presented with dry cough and breathlessness, which led to the discovery of a right pleural effusion exhibiting lymphocytic predominance with high ADA but lacking malignant cells. Prompt initiation of empiric anti-tubercular therapy (ATT) resulted in symptomatic improvement and resolution of the effusion. However, subsequent admission to the emergency room due to vomiting, weakness, and walking difficulties unveiled a positive rapid antigen test for COVID-19 and identified moderate right-sided pleural effusion. Additional investigations including positron emission tomography–computed tomography (PET-CT), magnetic resonance imaging (MRI) brain, and cell block analysis unveiled intriguing findings, prompting further evaluation and immunohistochemical (IHC) analysis. IHC markers revealed CD20+, Ki-67 proliferation index of 80%, CD79a+, CD 3 -, CD138-, CD30-, and CD10-, indicative of atypical B cell proliferation. Importantly, the presence of human herpes virus-8 (HHV-8) was confirmed through LANA1 staining, solidifying the diagnosis of primary effusion lymphoma. This case highlights the diagnostic challenges encountered and emphasizes the importance of comprehensive evaluation and IHC profiling confirmation in establishing an accurate diagnosis of PEL.
ABSTRACT
Pulmonary pleomorphic carcinoma (PPC) is an uncommon primary lung tumor with a low incidence and aggressive biological characteristics that can occur in young people and nonsmokers. Pleomorphic carcinoma (PC) has a worse prognosis than other non-small cell lung tumors. We describe a 45-year-old man who complained of having a dry cough for a month. A well-defined mass in the anterior section of the left lower lobe was identified by chest high-resolution computed tomography (HRCT), and a positron emission tomography (PET) scan confirmed a left lobulated tumor with fluorodeoxyglucose (FDG) uptake in the left mediastinal lymph nodes. An endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) guided biopsy of the tumor was performed and sent for histopathological analysis, which identified pleomorphic squamous cells and giant cells. Positive IHC markers included P63, TTF1, pancytokeratin, Vimentin. Patient was diagnosed with stage IIIa (T3N2M0) pleomorphic carcinoma of the lung. Due to the tumor's advanced stage, the patient received chemotherapy and radiation therapy.
ABSTRACT
Pulmonary pleomorphic carcinoma (PPC) is an uncommon primary lung tumor with a low incidence and aggressive biological characteristics that can occur in young people and nonsmokers. Pleomorphic carcinoma (PC) has a worse prognosis than other non-small cell lung tumors. We describe a 45-year-old man who complained of having a dry cough for a month. A well-defined mass in the anterior section of the left lower lobe was identified by chest high-resolution computed tomography (HRCT), and a positron emission tomography (PET) scan confirmed a left lobulated tumor with fluorodeoxyglucose (FDG) uptake in the left mediastinal lymph nodes. An endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) guided biopsy of the tumor was performed and sent for histopathological analysis, which identified pleomorphic squamous cells and giant cells. Positive IHC markers included P63, TTF1, pancytokeratin, Vimentin. Patient was diagnosed with stage IIIa (T3N2M0) pleomorphic carcinoma of the lung. Due to the tumor's advanced stage, the patient received chemotherapy and radiation therapy.