In a patient treated for acute myeloblastic leukemia (AML), we saw an angiocentric and angiodestructive lymphoma that resembled lymphomatoid granulomatosis (LG). The lesions tended to involve extranodal sites such as the lung, the parotid gland, and the skin. The immunologic studies showed that the proliferating lymphoid cells were mature T cells. Furthermore, genotypic studies disclosed a clonal rearrangement of the beta T-cell receptor gene. It is concluded that this case of LG is related to a neoplastic T-cell lymphoproliferative disorder. The relations between LG and the previous AML are discussed.
Cancer 65:107-111, 1990.
YMPHOMATOID GRANULOMATOSIS (LG) is an an-L giocentric and angiodestructive granuloma with a polymorphous and pleiomorphic infiltrate. The nature of T-cell maturation in the proliferating cells has been disclosed recently, but genotypic studies have been done rarely. We report a case of LG with histologic, immunologic, and genotypic pulmonary studies. The proliferating lymphoid cells were mature T cells with a clonal rearrangement involving the / 3 1 gene. Another important factor was acute myeloblastic leukemia (AML) in complete remission 16 months before the diagnosis of LG. The mechanisms of this association are reported.
Case Report
A 65-year-old white woman was diagnosed in May 1986 as having AML M5 type according to the current French-American-British (FAB) classification.' Medullary blast cells were positive with CD14b, CDI 3, CD33, My8, and 12 monoclonal antibodies as reported previously.* In contrast, no staining with B and T monoclonal antibodies was seen (Table 1). Complete remission was obtained with induction chemotherapy including lomustine (120 mg, day I), cytarabine (150 mg, from day 1 to day lo), and doxorubicin (50 mg, days 1, 2, and 3).3 Maintenance chemotherapy with 6-thioguanine, cytarabine, lomustine, and doxorubicin was discontinued in June 1987 because of pancytopenia. The bone marrow biopsy showed hypoplasia and persistant remission. Pancytopenia resolved slowly.