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Howell NA, Arya S, Tai PC, Sadeghian H, Sakhdari A, Wu R, Prica A. Guillain-Barré syndrome as an early manifestation of angioimmunoblastic T-cell lymphoma. BMJ Case Rep 2022; 15:e246176. [PMID: 35589261 PMCID: PMC9121415 DOI: 10.1136/bcr-2021-246176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare condition caused by autoimmune damage of peripheral nerves. We describe a case where a man in his 80s presented with subacute, progressive fatigue and weakness. He had received an outpatient work-up for possible haematological malignancy, but eventually presented to the emergency department for worsening weakness. A physical exam and cerebrospinal fluid analysis suggested a diagnosis of GBS. Subsequently, a pathological diagnosis of angioimmunoblastic T-cell lymphoma was made. The patient underwent intravenous immunoglobulin treatment for GBS and was started on cyclophosphamide, doxorubicin, vincristine and prednisone therapy. Prior research has suggested that incident malignancy may be associated with GBS, which may be caused by a paraneoplastic-type phenomenon, malignancy-associated immune dysregulation or an autoimmune reaction triggered by a common exposure. Clinicians should be aware of the possible association between these two conditions and should remain open minded to the possibility of non-infectious triggers for GBS.
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Affiliation(s)
| | - Sumedha Arya
- Division of Haematology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Peter C Tai
- Division of Neurology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Hamid Sadeghian
- Division of Neurology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Ali Sakhdari
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
| | - Robert Wu
- Division of General Internal Medicine, Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Anca Prica
- Division of Haematology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Wakabayashi SI, Kimura T, Tanaka N, Joshita S, Kawata K, Umemura T, Hiroshima Y, Mori H, Kobayashi H, Wada S, Tanaka E. Emergence of anti-mitochondrial M2 antibody in patient with angioimmunoblastic T-cell lymphoma. Clin J Gastroenterol 2018; 11:302-308. [PMID: 29428971 DOI: 10.1007/s12328-018-0831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
A 68-year-old woman was referred to our hospital due to fever and rash on the neck and extremities. Laboratory findings revealed hepatic dysfunction and positivity for anti-mitochondrial M2 antibody (AMA-M2). Hepatosplenomegaly and systemic lymphadenopathy were detected by enhanced computed tomography. One week after her first visit, hypoxemia, ascites, and Coomb test-positive autoimmune hemolytic anemia had newly appeared in addition to worsened fever, hepatosplenomegaly, and lymphadenopathy. Results of axillary lymph node, skin, and bone-marrow biopsies led to the diagnosis of angioimmunoblastic T-cell lymphoma (AITL), for which CEPP therapy (cyclophosphamide, etoposide, procarbazine, and prednisolone) was initiated. Her serum levels of hepatobiliary enzymes normalized and AMA-M2 became negative after treatment. The unexpected positivity for AMA-M2 might have been caused by AITL cell-activated intrahepatic immune cells or the tumor cells themselves inflicting bile duct injury that mimicked primary biliary cholangitis. Alternatively, cross reactivity due to the overproduction of immunoglobulins may have caused this phenomenon. The present case may shed light on of the mechanisms of liver dysfunction accompanying AITL.
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Affiliation(s)
- Shun-Ichi Wakabayashi
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Naoki Tanaka
- Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Satoru Joshita
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazuhito Kawata
- Department of Hepatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeji Umemura
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yuki Hiroshima
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hiromitsu Mori
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Shuichi Wada
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Eiji Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Uncommon late relapse of angioimmunoblastic T-cell lymphoma after 16-year remission period. Pathol Oncol Res 2011; 18:737-41. [PMID: 22127590 DOI: 10.1007/s12253-011-9475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 11/03/2011] [Indexed: 10/15/2022]
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Dearden CE, Johnson R, Pettengell R, Devereux S, Cwynarski K, Whittaker S, McMillan A. Guidelines for the management of mature T-cell and NK-cell neoplasms (excluding cutaneous T-cell lymphoma). Br J Haematol 2011; 153:451-85. [PMID: 21480860 DOI: 10.1111/j.1365-2141.2011.08651.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The peripheral T-cell neoplasms are a biologically and clinically heterogeneous group of rare disorders that result from clonal proliferation of mature post-thymic lymphocytes. Natural killer (NK) cell neoplasms are included in this group. The World Health Organization classification of haemopoietic malignancies has divided this group of disorders into those with predominantly leukaemic (disseminated), nodal, extra-nodal or cutaneous presentation. They usually affect adults and are more commonly reported in males than in females. The median age at diagnosis is 61 years with a range of 17-90 years. Although some subtypes may follow a relatively benign protracted course most have an aggressive clinical behaviour and poor prognosis. Excluding anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL), which has a good outcome, 5-year survival for other nodal and extranodal T-cell lymphomas is about 30%. Most patients present with unfavourable international prognostic index scores (>3) and poor performance status. The rarity of these diseases and the lack of randomized trials mean that there is no consensus about optimal therapy for T- and NK-cell neoplasms and recommendations in this guideline are therefore based on small case series, phase II trials and expert opinion.
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Notas G, Xylouri I, Kritikos H, Stavroulaki E, Roditakis G, Boumpas D. A rare case of angioimmunoblastic T-cell lymphoma presenting with fever and late polyarthritis. Rheumatology (Oxford) 2009; 48:859-60. [DOI: 10.1093/rheumatology/kep092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Ahmet Dogan
- Department of Histopathology, University College London, London, UK.
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Borisch B, Caioni M, Hurwitz N, Dommann-Scherrer C, Odermatt B, Waelti E, Laeng RH, Kraft R, Laissue J. Epstein-Barr virus subtype distribution in angioimmunoblastic lymphadenopathy. Int J Cancer 1993; 55:748-52. [PMID: 8244571 DOI: 10.1002/ijc.2910550509] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The tissues of 16 patients bearing a T-cell lymphoma of angioimmunoblastic lymphadenopathy type (AILD-TCL) were investigated for the distribution of Epstein-Barr virus (EBV) subtypes 1 and 2. EBV-association had been proven in these cases by polymerase chain reaction (PCR) for EBV-DNA, in situ hybridization (ISH) for EBV-encoded small nuclear RNAs (EBER) and immunohistology for EBV-encoded latent membrane protein (LMP). PCR and EBER-ISH produced mostly identical results, but some cases were positive with only one of the 2 methods employed. LMP was detected in a few large cells of 8/13 cases. Twelve cases were investigated for the distribution of EBV subtypes. One case contained EBV genome of subtype 2, 3 cases contained subtype 1 and 4 cases contained both subtypes. Four cases could not be typed. These findings suggest that in AILD, as in AIDS-associated lymphomas and lymphomas of the lethal midline granuloma type, subtype 2 of EBV may occur, perhaps in relation to an immunodysfunction developing progressively in these patients.
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Affiliation(s)
- B Borisch
- Pathologisches Institut, Universität Bern
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Affiliation(s)
- I L Levey
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234
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Abstract
Bone marrow biopsies from 13 cases of lymph-node-biopsy-proven angioimmunoblastic lymphadenopathy (AILD) were studied. Eight cases (62%) showed a characteristic 'granulomatoid' lymphoreticular infiltrate composed of a mixture of lymphocytes, epithelioid histiocytes, immunoblasts, plasma cells and eosinophils in varying proportions. Proliferation of blood vessels, although much less prominent than that described in lymph nodes, and a marked degree of reticulin fibrosis were also noted. The pattern of involvement was mainly focal and rarely diffuse. The foci were either single or multiple, and were distributed throughout the marrow but were only rarely paratrabecular. The associated haematopoietic marrow findings were nonspecific regardless of degree of bone marrow involvement. The histopathology of involved bone marrows in angioimmunoblastic lymphadenopathy is such that in some cases it should strongly suggest the diagnosis even in the absence of a prior definitive lymph node biopsy. Differentiating features from other disorders that might be confused with AILD are discussed. Survival rate was adversely affected by bone marrow involvement.
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Gardais J, Fanello S, Joubaud F, Simard C. [Leukemoid eosinophilic reaction in angioimmunoblastic adenopathy]. Rev Med Interne 1984; 5:309-14. [PMID: 6522879 DOI: 10.1016/s0248-8663(84)80007-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case of eosinophilic leukemoid reaction is described. This picture is seldom encountered during the course of angio-immunoblastic adenopathy. After reviewing various diagnoses and pointing out similar cases of the literature, the authors discuss the possible pathophysiologic mechanisms of eosinophilia in this disorder.
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Abstract
A quantitative analysis of leukocytes in the peripheral blood of 16 patients with lymphogranulomatosis X revealed the following findings: The number of total leukocytes, monocytes, neutrophils, and eosinophils varied considerably and showed no clear common tendency. Blood basophils were found to be clearly increased with a mean value of 0.17 +/- 0.18 X 10(9)/1 as compared to 55 normal donors (0.04 +/- 0.01 X 10(9)/1). Lymphocyte counts were within the normal range. Lymphopenia was seen in 2 patients. Lymphocytes with azure granules which encompass T-suppressors were found to exceed normal values by a factor of 15. In 14 cases a variable number of hyperbasophil cells were present. Lymphogranulomatosis X seems to present with a characteristic blood picture which might be of diagnostic aid.
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Minerbrook M, Budman DR, Schulman P, Vinciguerra V, Degnan TJ, Coffey E. De novo disseminated intravascular coagulation in angioimmunoblastic lymphadenopathy (AILD). Cancer 1983; 51:1927-30. [PMID: 6831357 DOI: 10.1002/1097-0142(19830515)51:10<1927::aid-cncr2820511028>3.0.co;2-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
An elderly woman with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) presented de novo with DIC in the absence of other etiologic causes for DIC. Complete reversal of the defibrination process occurred with vincristine, methyl-prednisolone, and heparin therapy. This case illustrates that defibrination can occur de novo in the presence of a clinically, although not pathologically, malignant process. AILD should be considered in the differential diagnosis of DIC.
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Abstract
Bone marrow biopsies are now widely used in the investigation and follow-up of many diseases. Semi-thin sections of 8216 undecalcified biopsies of patients with haematological disorders were studied. Observations were made on the cytopenias and the myelodysplastic syndromes, the acute leukaemias the myeloproliferative disorders, Hodgkin's disease and the malignant lymphomas including multiple myeloma, hairy cell leukaemia and angioimmunoblastic lymphadenopathy. Bone marrow biopsies are essential for the differential diagnosis of most cytopenias and for the early recognition of fibrosis which most frequently occurred as a consequence of megakaryocytic proliferation in the myeloproliferative disorders. Different patterns of bone marrow involvement were found in the lymphoproliferative disorders and both their type and extent constituted factors of prognostic significance. A survey of the literature is given and the conclusion is drawn that bone marrow biopsies provide indispensible information for the diagnostic evaluation and the follow-up of patients with haematological disorders.
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Trenchard PM, Whittaker JA, Gough J, Parry H. Rapidly fatal respiratory failure and angioimmunoblastic lymphadenopathy: possible contributions of immunoblastic leukaemia, chemotherapy, and multiple antibodies directed against mature blood cells. J Clin Pathol 1981; 34:486-94. [PMID: 7251891 PMCID: PMC493330 DOI: 10.1136/jcp.34.5.486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A patient with angioimmunoblastic lymphadenopathy, immunoblastic leukaemia, pulmonary immunoblastic infiltration, and multiple antihaemocytic antibodies in his serum deteriorated rapidly after chemotherapy due to severe progressive respiratory of dysfunction. The haematological and immunological changes that accompanied this are described and discussed in the light of the pulmonary changes observed at necropsy of pulmonary oedema, fibrinous thrombi within venules, and immunoblastic infiltration of these thrombi and the venule walls. A pathophysiological mechanism is postulated in an attempt to rationalise these findings, and to act as a guide for the future assessment and management of similar cases.
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Swann RA, Slack MP, Wheldon DB. Use of Intralactam for the early detection of staphylococcal beta-lactamase. J Clin Pathol 1979; 32:1070-2. [PMID: 391822 PMCID: PMC1145895 DOI: 10.1136/jcp.32.10.1070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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