Senjo Hajime, Mori Akio, Kanaya Minoru, Izumiyama Koh, Okada Kohei, Takeyabu Kimihiro, Tobioka Hirotoshi, Saito Makoto, Tanaka Masanori, Teshima Takanori, Morioka Masanobu
Department of Hematology, Aiiku Hospital.
Department of Hematology, Hokkaido University.
Nihon Ronen Igakkai Zasshi. 2018;55(1):143-147. doi: 10.3143/geriatrics.55.143.
An 84-year-old man, who had received artificial pneumothorax for pulmonary tuberculosis 67 years previously, complained of severe chest pain. Chest CT revealed chronic pyothorax with multiple heterogeneously enhanced cavity lesions in the wall of the right intrathoracic space. FDG-PET revealed that the lesions showed an abnormal uptake. CT-guided biopsy was performed and he was diagnosed with pyothorax-associated lymphoma (PAL); the histological diagnosis was diffuse large B cell lymphoma (DLBCL). Furthermore, immunohistochemical staining revealed that the tumor cells were positive for EBNA-2 and LMP-1, suggesting that the latent gene products of Epstein-Barr virus were associated with the development of PAL. The patient was treated with chemotherapy, including rituximab; however, the treatment was discontinued due to the development of severe delirium after chemotherapy. We should keep in mind that elderly patients with a long history of chronic pyothorax are at risk of developing malignant lymphoma. We report the present case with a brief review of the literature.
一名84岁男性，67年前曾因肺结核接受人工气胸治疗，现主诉严重胸痛。胸部CT显示慢性脓胸，右胸腔壁有多个强化不均匀的空洞病变。FDG-PET显示这些病变有异常摄取。进行了CT引导下活检，他被诊断为脓胸相关淋巴瘤（PAL）；组织学诊断为弥漫性大B细胞淋巴瘤（DLBCL）。此外，免疫组化染色显示肿瘤细胞EBNA-2和LMP-1呈阳性，提示爱泼斯坦-巴尔病毒的潜伏基因产物与PAL的发生有关。该患者接受了包括利妥昔单抗在内的化疗；然而，化疗后因出现严重谵妄而停止治疗。我们应牢记，有慢性脓胸长期病史的老年患者有发生恶性淋巴瘤的风险。我们报告本病例并简要回顾文献。
