Jiang JH, Zhang CL, Wu QL, Liu YH, Wang XQ, Wang XL, Fang BM. Rapidly progressing primary pulmonary lymphoma masquerading as lung infectious disease: A case report and review of the literature. World J Clin Cases 2021; 9(16): 4016-4023 [PMID: 34141761 DOI: 10.12998/wjcc.v9.i16.4016]
Corresponding Author of This Article
Bing-Mu Fang, MD, Chief Doctor, Department of Hematology, Lishui City People's Hospital, No. 15 Dazhong Street, Lishui 323000, Zhejiang Province, China. lishuishi1069@163.com
Research Domain of This Article
Hematology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jin-Hong Jiang, Yong-Hua Liu, Xiao-Qiu Wang, Xiao-Li Wang, Bing-Mu Fang, Department of Hematology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
Chun-Lai Zhang, Department of Ultrasonography, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
Qin-Li Wu, Department of Pathology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
Author contributions: Fang BM contributed to conceptualization and formal analysis; Wu QL contributed to data curation; Wang XQ contributed to funding acquisition; Jiang JH contributed to investigation, methodology, and project administration; Zhang CL contributed to providing resources; Liu YH provided software and contributed to supervision and validation; Wang XL contributed to data visualization; Jiang JH wrote the original draft; Fang BM reviewed and edited the manuscript.
Informed consent statement: Informed written consent was obtained from the family member of the patient for publication of this report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bing-Mu Fang, MD, Chief Doctor, Department of Hematology, Lishui City People's Hospital, No. 15 Dazhong Street, Lishui 323000, Zhejiang Province, China. lishuishi1069@163.com
Received: January 9, 2021 Peer-review started: January 9, 2021 First decision: February 11, 2021 Revised: February 22, 2021 Accepted: March 24, 2021 Article in press: March 24, 2021 Published online: June 6, 2021 Processing time: 116 Days and 0.3 Hours
Abstract
BACKGROUND
Primary anaplastic large cell lymphoma of the lung represents a diagnostic challenge due to diverse manifestations and non-specific radiological findings, particularly in cases that lack extra-pulmonary manifestations and lung biopsy.
CASE SUMMARY
A 40-year-old woman presented with a 6-d history of fever, dry coughing, and dyspnea. Her white blood cell count was 20100/mm3 with 90% neutrophils. PaO2 was 60 mmHg and SaO2 was 90% when breathing ambient air. Chest computed tomography (CT) identified a solid nodule, 15 mm in diameter, with a poorly defined boundary in the upper right lung, and several smaller solid nodules throughout both lungs. Pulmonary artery CT and subsequent bedside X-ray showed diffuse patchy shadows throughout both lungs. Repeated cultures of blood samples and alveolar lavage failed to identify any pathogen. Due to the mismatch between clinical and imaging features, we conducted a bone marrow biopsy, and the results showed proliferation along all three lineages but no atypical or malignant cells. The patient received empirical antibacterial, antiviral, and antifungal treatments, as well as corticosteroids. The patient’s condition deteriorated rapidly despite treatment. The patient died 6 d after hospitalization due to respiratory failure. Post-mortem lung biopsy failed to show inflammation but identified widespread infiltration of alveolar septum by anaplastic lymphoma kinase (ALK)-positive anaplastic cells.
CONCLUSION
ALK-positive anaplastic large cell lymphoma could present as a primary pulmonary disease without extra-pulmonary manifestations.
Core Tip: Primary anaplastic large cell lymphoma of the lung represents a diagnostic challenge due to diverse manifestations and non-specific radiological findings. We report a case of rapidly progressing anaplastic lymphoma kinase (ALK)-positive primary pulmonary anaplastic large cell lymphoma (ALCL) with bilateral multiple pulmonary consolidations, presenting initially as an acute lung infectious disease. ALK-positive ALCL could present as a primary pulmonary disease without extra-pulmonary manifestations.
