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Evaluation of Pulmonary Nodule in Mantle Cell Lymphoma
( Amar Ranjan ),( Harshita Dubey ),( Pranay Tanwar ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0
Introduction Mantle cell lymphoma (MCL) is an aggressive non-Hodgkin lymphoma (NHL) with median survival 3 -4 years from diagnosis. Method A case was retrieved from Hospital Record. Short Clinical History A 64 year old male presented with generalized lymphadenopathy. Hemogram showed TLC 12200/ cmm with 70% lymphoid cells in blood smear. Bone marrow (BM) aspirate smear showed 70% abnormal lymphoid cells, which was supported by biopsy (CD20+, CD3-). Viral markers were negative. Lymph node biopsy showed lymphoid cell positive for CD20, CD5 & Cyclin D and negative for CD3 & CD23; indicating MCL. Management with 6 # Bendamustine & Rutiximab resulted into clinical and hematological improvement. After 17 months of treatment free interval (TFI), he presented with Peripheral Neuropathy Grade -III, with no hematological or radiological abnormality. Pregabalin was advised. Again after 2 months (19 months of TFI) he presented with left inguinal lymphadenopathy. Biopsy from lymph node as well as BM showed abnormal lymphoid cells positive for CD20, CD5 & Cyclin D and negative for CD3, CD23, CD10 & BCL-6, MCL relapse was suggested. After 3 # CHOP type II Diabetes was detected. After 6 # CHOP chemotoxicity like fever, cough, vomiting, mucositis, oral ulcer etc. were noticed, which were managed conservatively along with Linalidomide and Prednisolone. Follow up x-ray & HRCT showed nodular lesions in right upper/ mid lobe; therapy for pulmonary Tuberculosis was started. Later he presented with painless and gradually increasing swelling in left thigh, for which radiotherapy showed partial relief. Doppler study for the cause of thigh swelling suggested a partial thrombus in left proximal Great saphanous vein, Lenalidomide induced Dddep vein thrombosis was considered, which was managed with anticoagulants. The case expired after some days. Conclusion Relapsed MCL cases are prone to develop Tuberculosis in developing countries leading to death.
Infective Lesions in Lung in Mantle Cell Lymphoma
( Harshita Dubey ),( Amar Ranjan ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0
Introduction Mantle cell lymphoma (MCL) constitutes 2-10% of Non Hodgkin Lymphoma. It is a B-cell neoplasm, composed of small to medium sized cells. Short Clinical History A 55/ F presented with progressive painful swelling in neck & bilaterally enlarged tonsils for 1 year. No hepatosplenomegaly or B- symptom was seen. Hemogram was normal. Bone Marrow (BM) examination and biopsy showed no lymphoma infiltration. PET-CT showed generalized lymphadenopathy involving cervical, supra & infra-diaphragmatic & pelvic regions. In Chest nodular opacities were seen in both lower lobes and in anterior & inferior segment of left upper lobe (8 mm size). No pulmonary parenchymal lesion with increased FDG uptake was seen. Liver was enlarged with fatty changes. NHL was suggested. Lymph node biopsy showed infiltration by large lymphocytes, positive for CD20, CD5, BCL-2, Cyclin D and negative for CD3, CD10, BCL6, MUM1, CD23. Proliferation marker for Ki 67 was 50%. MCL stage 4 was advised. Viral markers were negative. After 6# RCHOP, clinical & radiological remission was seen. ASCT was refused by the patient. Repeat CT scan was normal. PET-CT showed physiological FDG uptake in myocardium. No abnormal FDG uptake was seen in lungs, mediastinum or thoracic wall. Lungs airways, pleura, heart, vessels and other mediastinal structures were normal. After these 10 doses of maintenance therapy with Rituximab patient is performing well and spent treatment free for last one & half year with MIPI 3. Discussion & Conclusion Nodular lesions in lungs seen prior to therapy were subsided now, which may be of infective origin. A careful monitoring of lung nodule is must in a case of MCL. Lung involvement is not uncommon with NHL, but it is rare for mantle cell lymphoma to involve the lung parenchyma.