Taniguchi Ayuko, Hashida Yumiko, Nemoto Yuiko, Machida Hisanori, Chi SungGi, Ikezoe Takayuki, Yokoyama Akihito, Daibata Masanori
Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Kochi, Japan.
Acta Haematol. 2015;134(3):155-60. doi: 10.1159/000380809. Epub 2015 May 5.
Pyothorax-associated lymphoma (PAL) develops from a pyothorax caused by an artificial pneumothorax created during the treatment of pulmonary tuberculosis or tuberculous pleuritis. We report the first case of Epstein-Barr virus (EBV)-positive PAL arising from a posttraumatic empyema. A 75-year-old woman with chronic posttraumatic empyema presented with a tumor, which was connected to the wall of a pyothorax in the right thoracic cavity. She had a history of trauma to the right chest, which had occurred at the age of 45 years and had caused the chronic posttraumatic empyema. Pathological features of the resected tumor were conclusive for a diagnosis of EBV-positive PAL. Although neither postoperative chemotherapy nor radiotherapy was performed, remission was maintained for 3 years until recurrence in the liver. Combination chemotherapy led to complete remission, and 9 years after the initial diagnosis of PAL, the patient is still alive. An intriguing finding is the phenotypic alteration during the disease course. Although the primary tumor was negative for CD20 and CD3, the recurrent tumor expressed both of these molecules. We discuss this case of PAL, which was not a complication of lung tuberculosis, and the aberrant chronological phenotypic change observed in the lymphoma cells, and compare it with a usual case of PAL.
脓胸相关淋巴瘤（PAL）由肺结核或结核性胸膜炎治疗期间人工气胸导致的脓胸发展而来。我们报告首例由创伤后脓胸引起的爱泼斯坦-巴尔病毒（EBV）阳性PAL病例。一名患有慢性创伤后脓胸的75岁女性出现一个肿瘤，该肿瘤与右胸腔脓胸壁相连。她有右胸外伤史，45岁时发生，导致了慢性创伤后脓胸。切除肿瘤的病理特征确诊为EBV阳性PAL。尽管术后既未进行化疗也未进行放疗，但缓解期维持了3年，直到肝脏复发。联合化疗导致完全缓解，在PAL初次诊断9年后，患者仍然存活。一个有趣的发现是病程中的表型改变。尽管原发肿瘤CD20和CD3呈阴性，但复发肿瘤表达这两种分子。我们讨论了这例并非肺结核并发症的PAL病例以及淋巴瘤细胞中观察到的异常时间表型变化，并将其与PAL的常见病例进行比较。
