Ishiguro Takashi, Takayanagi Noboru, Yanagisawa Tsutomu, Kagiyama Naho, Saito Hiroo, Sugita Yutaka, Kojima Masaru
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya.
Intern Med. 2009;48(16):1425-8. doi: 10.2169/internalmedicine.48.2338. Epub 2009 Aug 17.
A 68-year-old man was admitted to our hospital for indistinct consciousness, progressive dyspnea, night sweats and fever of 2 weeks duration. Hypoxemia, thrombocytopenia, and elevated serum lactate dehydrogenase were found. Computed tomography was negative except for a small bilateral pleural effusion. Chest perfusion scintigraphy showed inhomogeneous perfusion thought unlikely to be pulmonary artery thromboembolism. Intravascular large B-cell lymphoma was suspected, and a pulmonary microvascular cytology specimen was obtained that contained numerous large lymphoma cells. Because the patient's condition was rapidly deteriorating, we started chemotherapy on the basis of the pulmonary microvascular cytology findings, and he improved. Later, atypical lymphocytes similar to those in the pulmonary microvascular cytology specimen were found in a bone marrow specimen. He was diagnosed as having diffuse large B-cell lymphoma. Because lymphoma cells were found in the pulmonary microvasculature, intravascular lymphoma was also diagnosed. Pulmonary microvascular cytology was helpful to detect lymphoma cells in the pulmonary microvasculature.
一名68岁男性因意识不清、进行性呼吸困难、盗汗及发热2周入院。发现有低氧血症、血小板减少及血清乳酸脱氢酶升高。计算机断层扫描除双侧少量胸腔积液外无异常。胸部灌注闪烁显像显示灌注不均匀，不太可能是肺动脉血栓栓塞。怀疑为血管内大B细胞淋巴瘤，获取的肺微血管细胞学标本中含有大量大淋巴瘤细胞。由于患者病情迅速恶化，我们根据肺微血管细胞学检查结果开始化疗，患者病情好转。后来，在骨髓标本中发现了与肺微血管细胞学标本中相似的非典型淋巴细胞。他被诊断为弥漫性大B细胞淋巴瘤。由于在肺微血管中发现了淋巴瘤细胞，也诊断为血管内淋巴瘤。肺微血管细胞学有助于检测肺微血管中的淋巴瘤细胞。
