Tumor necrosis factor- and interleukin-6-producing high-grade B-cell lymphoma, not otherwise specified in the pleura

Our plain-English summary of Tumor necrosis factor- and interleukin-6-producing high-grade B-cell lymphoma, not otherwise specified in the pleura, by S. Nakayama, M. Matsuda, T. Adachi, et al (Leukemia Research Reports, 2018).

The study

• Authors: S. Nakayama, M. Matsuda, T. Adachi, S. Sueda, K. Ueda, K. Kawahara, Y. Ohashi, S. Awaji, S. Hashimoto, I. Matsumura
• Journal: Leukemia Research Reports
• Published: 2018;10:1-3
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 65-year-old man was admitted to our hospital with left-sided chest and back pain and dyspnea. Computed tomography demonstrated a marked circumferential left pleural thickening. A thoracoscopic pleural biopsy led to a diagnosis of high-grade B-cell lymphoma, not otherwise specified (HGBL, NOS). Lymphoma cells were positive for tumor necrosis factor (TNF) and interleukin-6. This is the first case report of TNF- and IL-6-producing aggressive HGBL, NOS in the pleura, in which radiological findings mimicked pleural mesothelioma. The aggressive tumor progression in the present case may have been caused by abnormal cytokine production from lymphoma cells.

In plain English

This article is a case report about one man in Japan who had a high-grade B-cell lymphoma, not otherwise specified (HGBL, NOS), a fast-growing blood cancer, in the lining of the lung (the pleura). The case text gives his age as 62, while the article's abstract says 65. He had been exposed to asbestos while working as a pipe fitter and wrecker for more than 30 years. The article does not name the fiber type. He had no history of tuberculosis. A CT scan showed marked thickening all around the left pleura and fluid in the left chest. Because of these scan findings and his asbestos history, pleural mesothelioma was suspected at first. A biopsy instead showed lymphoma, and the cancer cells tested positive for two signaling proteins, TNF and IL-6. After 2 courses of chemotherapy the thickening shrank, but after 3 courses the tumor grew again. After 3 courses of a second chemotherapy regimen, the tumor disappeared on CT. The authors suggested the cytokines might be linked to the aggressive growth. They concluded that doctors should consider lymphoma in patients with asbestos exposure and pleural thickening, and that a biopsy is needed for diagnosis.

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 man, described as 62 years old in the case report text (65 in the abstract), admitted to a hospital in Japan with left-sided chest and back pain and shortness of breath (dyspnea)
• Exposure: Work as a pipe fitter and wrecker for more than 30 years, with asbestos exposure; no fiber type stated; no history of tuberculosis
• Main results:
  • The CT scan on admission showed marked thickening all around the left pleura and fluid in the left chest
  • Pleural mesothelioma was suspected at first, because of the scan findings and the asbestos history
  • The pleural biopsy led to a diagnosis of high-grade B-cell lymphoma, not otherwise specified, under the 2017 WHO classification
  • The lymphoma cells tested positive for TNF and IL-6
  • About 90% of the lymphoid cells were positive for Ki67, a marker of how fast cells are dividing
  • The pleural thickening shrank after 2 courses of R-CHOP chemotherapy, but the tumor grew again after 3 courses
  • After 3 courses of salvage chemotherapy with R-Hyper CVAD/MA, the tumor disappeared on CT
  • The authors suggested the aggressive tumor growth might be associated with abnormal cytokine production by the lymphoma cells
• The authors' conclusion: The authors concluded that physicians need to consider lymphoma in patients with a history of asbestos exposure and pleural thickening. They added that a biopsy is required, because on scans this can be confused with pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Necrosis, Pleura, Dyspnea, Pleural Thickening, Pleural Biopsy, Pleural Mesothelioma, Cytokine.

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