Fukui Sayato, Kura Yoshimasa
Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, JPN.
Department of Hematology, Kasukabe Municipal Medical Center, Kasukabe, JPN.
Cureus. 2024 Sep 9;16(9):e68969. doi: 10.7759/cureus.68969. eCollection 2024 Sep.
We report the case of a 60-year-old male with a fever for two months and a skin rash for approximately one month prior to visiting his local doctor and subsequent admission to the hospital. Clinical findings included fever, weight loss, and night sweats. Computed tomography (CT) revealed an irregularly shaped mass bordering the upper lobe of the left lung and mediastinum, as well as hepatosplenomegaly. Suspecting lung cancer or malignant lymphoma, the patient was referred to our hospital for further evaluation. Positron emission tomography-computed tomography (PET/CT) revealed hepatosplenomegaly with accumulation of contrast agents in the liver, spleen, and bone marrow, as well as in a mass in the left upper lobe. A liver biopsy revealed atypical cells in the sinusoids, and immunohistochemical staining confirmed B-cell lymphoma. Chemotherapy was initiated immediately. PET/CT at the follow-up evaluation showed that the hepatosplenomegaly and bone marrow-related accumulation of contrast agents had resolved, but the accumulation of contrast agents in the mediastinal lymph nodes and the left upper lobe mass persisted, despite shrinkage. A bronchoscopy and mediastinal lymph node biopsy were performed. Histopathological examination revealed that the lung mass was most likely a small-cell carcinoma of the lung. Clinically, the malignant lymphoma was considered intravascular large B-cell lymphoma. As a result of appropriate treatment for both cancers, the patient's survival period improved.
我们报告了一例60岁男性病例，该患者在前往当地医生处就诊并随后入院前，发热两个月，皮疹约一个月。临床检查结果包括发热、体重减轻和盗汗。计算机断层扫描（CT）显示左肺上叶和纵隔交界处有一个形状不规则的肿块，以及肝脾肿大。怀疑为肺癌或恶性淋巴瘤，该患者被转诊至我院作进一步评估。正电子发射断层扫描-计算机断层扫描（PET/CT）显示肝脾肿大，肝脏、脾脏和骨髓以及左上叶肿块中有造影剂积聚。肝脏活检显示肝血窦中有非典型细胞，免疫组化染色确诊为B细胞淋巴瘤。立即开始化疗。随访评估时的PET/CT显示，肝脾肿大及与骨髓相关的造影剂积聚已消退，但纵隔淋巴结和左上叶肿块中的造影剂积聚仍然存在，尽管有所缩小。进行了支气管镜检查和纵隔淋巴结活检。组织病理学检查显示，肺部肿块很可能是肺小细胞癌。临床上，恶性淋巴瘤被认为是血管内大B细胞淋巴瘤。由于对两种癌症都进行了适当治疗，患者的生存期得到了改善。
