Presentation
Weight loss and chronic cough. Presented with recent chest pain and shortness of breath.
Patient Data
Left hemithorax white-out with significant mediastinal shift into the right side.
The carinal angle is splayed for more than 90 degrees.
The left main bronchus shows cut off of gas lucency at its proximal part.
Obliteration of the retrosternal air space on the lateral X-ray, in keeping with anterosuperior mediastinal involvement.
A soft tissue mass at the anterior mediastinum that causes external compression and complete obstruction of the left mainstem bronchus, with resultant total left lung collapse. Also, there is an accompanying large left side pleural effusion which explains the mediastinal shift.
Pleural effusion was drained. Biopsy was arranged.
Case Discussion
HISTOPATHOLOGY
Microscopic description
- Atypical lymphoid cells (lymphoblasts) of small and intermediate size and having irregular, nucear cntours, dispersed chromatin, inconspicous nucleoli and scant cytoplasm. These cells are immunoreactive to CD3, CD5, CD10 and TdT; however, they are immunonegative to CD20, PAX5 and CD34. The proliferation index (Ki-67) is >90%.
Diagnosis
- T-cell lymphoblastic lymphoma.
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