Frontiers in medicine · 2025
Case Report: Rare pleural effusion-a case of B-lymphoblastic lymphoma presenting with pleural effusion and diagnostic challenges.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Lu Fang, Zong Wenkang, Yang Liheng, Zhang Dongrui, Jia Wei, Li Yi
Аннотация
BACKGROUND: Lymphoblastic lymphoma is a rare type of malignant lymphoma. B-lymphoblastic lymphoma with pleural effusion as the initial manifestation is extremely rare; in this study, we report a specific and challenging diagnostic process.
CASE PRESENTATION: We present the case of a 67-year-old woman who was initially diagnosed with tuberculous pleurisy with a right pleural effusion. The pleural effusion was an exudate composed primarily of mononuclear cells with elevated adenosine deaminase (ADA) and lactate dehydrogenase (LDH). The cytological results of the pleural effusion were negative. The contrast-enhanced CT suggested right pleural nodules with partial pleural thickening. Subsequently, a CT-guided percutaneous needle pleural biopsy was performed, and pathological consultation, bone marrow biopsy, and flow cytology examination were carried out. Finally, B-lymphoblastic lymphoma was diagnosed. During a recent follow-up, the patient showed signs of improvement nearly without pleural effusion after chemotherapy.
CONCLUSION: Malignant pleural effusion caused by lymphoma can be easily misdiagnosed as tuberculous pleurisy, as both conditions commonly show markedly elevated levels of ADA and LDH. Flow cytology examination of pleural fluid can be considered, and histological specimens should be actively obtained to clarify the pathological diagnosis. For patients with extensive pleural thickening, a CT-guided percutaneous pleural biopsy can be preferentially selected.
CASE PRESENTATION: We present the case of a 67-year-old woman who was initially diagnosed with tuberculous pleurisy with a right pleural effusion. The pleural effusion was an exudate composed primarily of mononuclear cells with elevated adenosine deaminase (ADA) and lactate dehydrogenase (LDH). The cytological results of the pleural effusion were negative. The contrast-enhanced CT suggested right pleural nodules with partial pleural thickening. Subsequently, a CT-guided percutaneous needle pleural biopsy was performed, and pathological consultation, bone marrow biopsy, and flow cytology examination were carried out. Finally, B-lymphoblastic lymphoma was diagnosed. During a recent follow-up, the patient showed signs of improvement nearly without pleural effusion after chemotherapy.
CONCLUSION: Malignant pleural effusion caused by lymphoma can be easily misdiagnosed as tuberculous pleurisy, as both conditions commonly show markedly elevated levels of ADA and LDH. Flow cytology examination of pleural fluid can be considered, and histological specimens should be actively obtained to clarify the pathological diagnosis. For patients with extensive pleural thickening, a CT-guided percutaneous pleural biopsy can be preferentially selected.