Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8102, Japan.
Department of Hematology, Nagasaki University Hospital, Nagasaki 852-8102, Japan.
Medicina (Kaunas). 2023 Nov 16;59(11):2015. doi: 10.3390/medicina59112015.
The diagnosis of pulmonary lymphoma using small tissue samples is difficult and often requires surgical procedures; thus, a less invasive sampling method is desirable. Moreover, pulmonary involvement in adult T-cell lymphoma (ATL) is often difficult to diagnose, especially in cases without characteristic flower cells. Here, we present the case of a 78-year-old man, in whom pathological examination of the transbronchial lung biopsy (TBLB) specimen did not reveal malignant findings; therefore, transbronchial lung cryobiopsy (TBLC) in combination with endobronchial ultrasonography (EBUS) was used to diagnose ATL based on the pathological findings. A literature review identified 18 cases of pulmonary lymphomas diagnosed using TBLC. Among the 19 cases, including our own, 16 cases were of B-cell lymphoma (84.2%), and the present case is the first case of ATL diagnosed using TBLC. Eighty percent of the cases underwent a biopsy (more than two samples) of the middle or lower lobe and were diagnosed without major complications. EBUS was used with TBLC in three cases to identify the location of the pulmonary lesions. In the present case, EBUS was also useful for avoiding vascular biopsy. Although large-scale prospective studies are required to establish precise guidelines for diagnosing pulmonary lymphomas using TBLC, our case report and review contributes to a deeper understanding of the diagnosis of rare diseases.
使用小组织样本诊断肺淋巴瘤很困难,通常需要手术程序;因此,需要一种微创的采样方法。此外,成人 T 细胞淋巴瘤(ATL)的肺部受累通常难以诊断,尤其是在没有特征性花细胞的情况下。在这里,我们报告了一例 78 岁男性的病例,其经支气管肺活检(TBLB)标本的病理检查未发现恶性发现;因此,根据病理结果,使用经支气管肺冷冻活检(TBLC)结合支气管内超声(EBUS)诊断 ATL。文献复习确定了 18 例使用 TBLC 诊断的肺淋巴瘤病例。在这 19 例病例中,包括我们自己的病例,16 例为 B 细胞淋巴瘤(84.2%),本病例是首例使用 TBLC 诊断的 ATL。80%的病例对中或下叶进行了活检(超过两个样本),且无重大并发症诊断。在三种情况下,使用 EBUS 结合 TBLC 来确定肺部病变的位置。在本病例中,EBUS 还有助于避免血管活检。尽管需要进行大规模的前瞻性研究来为使用 TBLC 诊断肺淋巴瘤制定精确的指南,但我们的病例报告和综述有助于加深对罕见疾病诊断的理解。