Kawakami Ayako, Kuroda Hiroyuki, Suzuki Takaharu, Kobayashi Hironori, Abe Seitaro, Ui Masahiro, Inoue Kanako, Oshima Koichi, Sone Hirohito, Takizawa Jun
Department of Hematology, Niigata Prefectural Shibata Hospital.
Department of Respiratory Medicine, Niigata Prefectural Shibata Hospital.
Rinsho Ketsueki. 2022;63(7):759-763. doi: 10.11406/rinketsu.63.759.
A 68-year-old male patient with lung adenocarcinoma, who was treated with chemotherapy and immune checkpoint inhibitors (ICIs), developed lymphadenopathy during treatment. His para-aortic lymph nodes increased to 2.0 cm in diameter. Both inguinal lymph nodes were 1.5 cm in diameter, and multiple hepatic masses appeared. After the ICI readministration, both inguinal lymph nodes increased to 2.0 cm in diameter, but the para-aortic lymph nodes and hepatic masses remained. Angioimmunoblastic T-cell lymphoma (AITL) diagnosis was established after the right inguinal lymph node biopsy, which was accompanied by an infiltration of Epstein-Barr virus (EBV)-encoded small ribonucleic acid-positive B-cells. After the ICI discontinuation, the inguinal lymph nodes decreased to 1.5 cm in diameter, but the para-aortic lymph nodes remained, and hepatic masses increased. Hepatic lesions were possibly lung cancer metastasis. The ICI administration and EBV reactivation were potentially associated with AITL development in the present case. The natural shrinkage of lymphoma after the ICI cessation implied the immunological mechanism like that of the methotrexate-related lymphoproliferative disease.
一名68岁的肺腺癌男性患者接受了化疗和免疫检查点抑制剂（ICI）治疗，治疗期间出现淋巴结病。其腹主动脉旁淋巴结直径增至2.0 cm。双侧腹股沟淋巴结直径均为1.5 cm，并出现多个肝脏肿块。再次给予ICI后，双侧腹股沟淋巴结直径增至2.0 cm，但腹主动脉旁淋巴结和肝脏肿块依然存在。右侧腹股沟淋巴结活检后确诊为血管免疫母细胞性T细胞淋巴瘤（AITL），伴有EB病毒编码的小核糖核酸阳性B细胞浸润。停用ICI后，腹股沟淋巴结直径降至1.5 cm，但腹主动脉旁淋巴结依然存在，且肝脏肿块增大。肝脏病变可能为肺癌转移。在本病例中，ICI给药和EB病毒再激活可能与AITL的发生有关。ICI停用后淋巴瘤自然缩小，提示其免疫机制与甲氨蝶呤相关的淋巴增殖性疾病类似。
