Department of Surgical Intensive Care Unit, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
BMC Pulm Med. 2021 Jan 14;21(1):27. doi: 10.1186/s12890-020-01360-y.
Extranodal natural killer/T cell lymphoma (ENKL) is a rare subtype of non-Hodgkin lymphoma, and lung involvement is extremely rare. The patients with pulmonary ENKL always presented unspecific symptoms of the respiratory system, such as cough with sputum and varying degrees of fever, while developing into acute respiratory distress (ARDS) was seldomly reported, especially promoted by the surgical procedure.
Here we describe a patient with nasal ENKL and most likely lung dissemination that was regarded as an infection at first. After nonresponse to a period of anti-infective therapy, this patient received surgical debridement. While the histopathology did not show the evidence of infection, but consistent with ENKL. The patient got refractory hypoxemia rapidly after surgery, with the LDH surging to a much higher level than before surgery. The ARDS was diagnosed, and he died on the 5th day after surgery. We postulate that ARDS was due to aggressive lymphoma proliferation promoted by the surgical procedure.
Pulmonary ENKL developing into ARDS was scarce, and was likely attributed to the aggressive tumor cell proliferation after surgery in this case.
结外自然杀伤/T 细胞淋巴瘤（ENKL）是一种罕见的非霍奇金淋巴瘤亚型，肺部受累极为罕见。患有肺部 ENKL 的患者常表现出呼吸系统的非特异性症状，如咳嗽、咳痰和不同程度的发热，而很少有报道称其发展为急性呼吸窘迫综合征（ARDS），尤其是由手术引起的。
本文描述了一例鼻 ENKL 伴肺部播散的患者，最初被认为是感染。在抗感染治疗一段时间后无反应后，该患者接受了手术清创。虽然组织病理学检查未显示感染证据，但与 ENKL 一致。术后患者迅速出现难治性低氧血症，LDH 水平比术前升高很多。诊断为 ARDS，术后第 5 天死亡。我们推测 ARDS 是由于手术促进了侵袭性淋巴瘤的增殖。
肺部 ENKL 发展为 ARDS 较为罕见，本例可能归因于手术后侵袭性肿瘤细胞的增殖。
