Endotracheal Anaplastic Large Cell Lymphoma-A Case Report and Literature Review

氣管內原發性異生性大細胞淋巴瘤－病例報告與文獻回顧

沈昱廷(Yu-Ting Shen) ； 劉大智(Ta-Chih Liu) ； 蔡志仁(Chee-Yin Chai) ； 楊志仁(Chih-Jen Yang) ； 王東衡(Tung-Heng Wang) ； 黃明賢(Ming-Shyan Huang)

《胸腔醫學》 29卷3期 (2014/06) Pp. 166-173

摘要

我們在此報告一個病例：五十二歲男性，主訴咳血，胸部X光片發現主支氣管分支角度增大，胸部電腦斷層發現主氣管分支下方有一腫瘤伴隨氣管與左側主支氣管內侵犯，支氣管鏡檢查發現有一腫瘤位於主氣管分支並伴隨左側支氣管近乎完全阻塞，切片檢查發現此腫瘤為一anaplastic lymphoma kinase（ALK）基因陰性之異生性大細胞淋巴瘤，正子造影檢查無發現其他器官或淋巴侵犯。經化學治療及放射治療後腫瘤完全緩解，並已在門診追蹤超過一年。氣管或支氣管內發生之異生性大細胞淋巴瘤為非常罕見之病例，目前已發表的案例報告均發生在三十歲以下，且均為ALK陽性。據我們所知，此病例為首次發現之五十歲以上及ALK陰性之支氣管內異生性大細胞淋巴瘤。因此，在年紀較大患者發生之支氣管內腫瘤應將此病列為鑑別診斷。

關鍵字

大細胞淋巴瘤 ； 氣管內腫瘤 ； 支氣管鏡

並列摘要

We describe a 52-year-old man who presented with hemoptysis. The chest radiograph showed a widened carinal angle, and the computed tomography (CT) of the chest revealed subcarinal lymphadenopathy with invasion into the trachea and left main bronchus. A mass at the main carina with nearly total obstruction of the left main bronchus was found with bronchoscopy. Biopsy of the lesion revealed anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL). No other organ or lymph node involvement was found on positron emission tomography. The patient had a complete remission after treatment with chemotherapy and radiotherapy. He has been followed up in the clinic without incident for more than a year. Endotracheal/endobronchial ALCL is very rare. All reported patients were younger than 30 years, and all of them had ALK-positive ALCL. To our knowledge, ours is the first case of endobronchial ALCL in a patient more than 50 years old and with ALK-negative ALCL. This case suggests that lymphoma should be included in the differential diagnoses of endobronchial tumor in older adults.

並列關鍵字

large cell lymphoma ； endotracheal tumor ； bronchoscopy