Mori Hiroyuki, Ebisawa Kei, Nishimura Mitsushige, Kanazawa Kenji
Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan.
Internal Medicine, Nishiizu Kenikukai Hospital, Kamo, Shizuoka, Japan.
BMJ Case Rep. 2018 Feb 17;2018:bcr-2017-221019. doi: 10.1136/bcr-2017-221019.
Extranodal natural killer (NK)/T cell lymphoma, nasal type is a condition that has poor prognosis. Accurate diagnosis of lymphoma is made by pathological findings. We report a case of extranodal NK/T cell lymphoma, nasal type affecting the lung and liver and which was difficult to diagnose because of negative biopsy results from multiple sites. A 39-year-old man who had dry cough and fever for 1 month was referred to our hospital. He had pancytopenia and elevated serum levels of lactate dehydrogenase and soluble interleukin-2 receptor. Hepatosplenomegaly and multiple lung nodules were found on imaging study. Specimens of bronchoscopic lung, percutaneous liver, bone marrow and random skin biopsies were all negative. Open lung biopsy was not definitive. Unfortunately, disease progression was rapid and fatal before results of pleural fluid cytology and a second liver biopsy showed extranodal NK/T cell lymphoma, nasal type. This report focused on diagnostic planning for rapidly progressive extranodal NK/T-cell lymphoma, nasal type.
结外自然杀伤（NK）/T细胞淋巴瘤，鼻型是一种预后较差的疾病。淋巴瘤的准确诊断依靠病理检查结果。我们报告一例结外NK/T细胞淋巴瘤，鼻型，累及肺和肝，因多处活检结果为阴性而难以诊断。一名39岁男性，干咳、发热1个月，转诊至我院。他全血细胞减少，血清乳酸脱氢酶和可溶性白细胞介素-2受体水平升高。影像学检查发现肝脾肿大和多个肺结节。支气管镜肺活检、经皮肝活检、骨髓活检及随机皮肤活检标本均为阴性。开胸肺活检结果不明确。不幸的是，在胸腔积液细胞学检查和第二次肝活检结果显示为结外NK/T细胞淋巴瘤，鼻型之前，疾病进展迅速并导致死亡。本报告重点关注快速进展性结外NK/T细胞淋巴瘤，鼻型的诊断策略。
