Lymphoproliferative disorder in pleural effusion in a subject with past asbestos exposure

Our plain-English summary of Lymphoproliferative disorder in pleural effusion in a subject with past asbestos exposure, by N. Hara, N. Fujimoto, Y. Miyamoto, et al (Respiratory Medicine Case Reports, 2015).

The study

• Authors: N. Hara, N. Fujimoto, Y. Miyamoto, T. Yamagishi, M. Asano, Y. Fuchimoto, S. Wada, S. Ozaki, T. Kishimoto
• Journal: Respiratory Medicine Case Reports
• Published: 2015;16:169-71
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary effusion lymphoma (PEL) is a subtype of non-Hodgkin lymphoma that presents as serous effusions without detectable masses or organomegaly. Here we report a case of PEL-like lymphoma in a patient with past asbestos exposure. A 65-year-old man was referred to our hospital due to dyspnea upon exertion. He had been exposed to asbestos for three years in the construction industry. Chest X-ray and CT images demonstrated left pleural effusion. Cytological analysis of the pleural effusion revealed large atypical lymphocytes with distinct nuclear bodies and high nucleus-to-cytoplasm ratio. Immunohistochemical analyses showed that the cells were CD20(+), CD3(-), CD5(-), and CD10(-). These findings led to a diagnosis of diffuse large B-cell lymphoma. PEL or PEL-like lymphoma should be considered a potential cause of pleural effusion in subjects with past asbestos exposure.

In plain English

This case report described one 65-year-old man in Japan who had shortness of breath on exertion. He had been exposed to asbestos from age 18 to 20 while cutting asbestos-containing building material in construction. The fiber type was not stated. Scans showed fluid around the left lung (pleural effusion) and calcified pleural plaques, with no pleural tumor, and a first pleural biopsy showed no malignancy. The fluid kept returning and was drained repeatedly. Four years after his first admission, fluid from the fourth drainage contained large atypical lymphocytes. A second biopsy led to a diagnosis of diffuse large B-cell lymphoma, which the authors called PEL-like lymphoma. Whole-body CT showed no enlarged lymph nodes or tumor, and testing for human herpesvirus 8 was negative. He showed no disease progression for 3 years. The authors said asbestos-related chronic inflammation might have played a role. They also noted that no link with asbestos has been established and that, given his short exposure, the disease may have developed independently. They concluded that this lymphoma should be considered as a possible cause of pleural effusion in people with past asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (a single patient)
• Who was studied: One 65-year-old man, an occasional smoker, referred for dyspnea on exertion to Okayama Rosai Hospital, Okayama, Japan; dates of care not given
• Exposure: Occupational asbestos exposure from age 18 to 20 in the construction industry, cutting asbestos-containing building material; fiber type not stated
• Main results:
  • At first presentation, CT showed left pleural effusion and calcified pleural plaques without pleural tumor
  • The first pleural fluid was 97.5% lymphocytes, and the first pleural biopsy showed no malignancy
  • Effusion recurred repeatedly; four years after first admission, fluid from the fourth thoracentesis showed large atypical lymphocytes
  • A repeat thoracoscopic biopsy and immunohistochemistry led to a confirmed diagnosis of diffuse large B-cell lymphoma
  • Whole-body contrast-enhanced CT (neck to pelvis) showed no lymphadenopathy or tumor
  • Over 3 years of follow-up, the patient showed no disease progression
• The authors' conclusion: The authors concluded that PEL or PEL-like lymphoma should be considered as a potential cause of pleural effusion in people with past asbestos exposure. They suggested that asbestos-induced chronic inflammation, together with advanced age, may possibly have triggered the disorder in this case.
• Limitations the authors state:
  • The authors note that no association between lymphoproliferative disorder and asbestos exposure has been established
  • The authors say the lymphoma may have developed independently of asbestos, given the relatively short exposure

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Asbestos Exposure, Dyspnea, Chest X-Ray.

Related studies

• Pulmonary crystal-storing histiocytoma in a patient without a lymphoproliferative disorder — W.S. Lee, S.R. Kim, et al. (2009)
• Prognostic significance of the lymphocyte-to-monocyte ratio in patients with malignant pleural mesothelioma — T. Yamagishi, N. Fujimoto, et al. (2015)
• Brain metastases in malignant pleural mesothelioma — T. Yamagishi, N. Fujimoto, et al. (2016)
• Lung function and respiratory symptoms in subjects with asbestos-related disorders: a cross-sectional study — B. Hilt, J.T. Lien, et al. (1987)
• Soluble mesothelin-related protein in pleural effusion from patients with malignant pleural mesothelioma — N. Fujimoto, K. Gemba, et al. (2010)
• Small intestinal intussusception in an adult — K. Takada, N. Fujimoto, et al. (2019)

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