A rare case of pulmonary lymphomatoid granulomatosis complicated with venous thrombosis

Main Article Content

Senem Maral
Murat Albayrak
Hacer Berna Afacan Öztürk
Funda Incekara
Abdulkerim Yıldız
Pınar Comert
Aynur Abayrak
Merih Reis Aras
Sadi Kaya

Keywords

Lymphomatoid granulomatosis, Venous thromboembolic events, Rituximab

Abstract

Lymphomatoid granulomatosis (LG) is Epstein-Barr virus associated, a rare aggressive B cell lymphoproliferative disease. The most common sites of involvement are lungs, skin, kidneys, liver and central nervous system. The clinical presentation of pulmonary LG can mimic infectious diseases, malignancies or vasculitis. While treatment approach of low grade disease is watch and wait, patients with advanced stage   require aggressive treatment with chemotherapy. Patients with hematological malignancy as well as solid tumors are at increased risk of venous thromboembolic events (VTE). We reported here in a case of pulmonary LG who was complicated with VTE during treatment with chemo-immunotherapy After 4 cycles of R-CHOP, she achieved complete remission for LG and was followed up without relapse for 2 years. She was anticoagulated with Low-Molecular-Weight Heparin (LMWH) during chemotherapy period, and the thrombus improved over the next several weeks. While on this paper written patient was pregnant with 10 weeks.

Abstract 498 | PDF Downloads 387

References

1. Vardiman JW. The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues: an overview with emphasis on the myeloid neoplasms. Chem Biol Interact. 2010; 184:16-20.
2. Pittaluga S, Wilson WH, Jaffe ES. Lymphomatoid granulomatosis. In: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Revised Fourth Edition, Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds), IARC, Lyon 2017. p.312.
3. Katzenstein AL, Carrington CB, Liebow AA. Lymphomatoid granulomatosis: a clinicopathologic study of 152 cases. Cancer 1979; 43:360.
4. Váróczy L, Gergely L, Szakáll S, Illés A. Angiocentric lymphomatoid granulomatosis and severe hypogammaglobulinaemia. Haematologia (Budap) 2002; 32:535.
5. Costiniuk CT, Karamchandani J, Bessissow A, Routy JP, Szabo J, Frenette C. Isolated EBV lymphoproliferative disease in a child with Wiskott-Aldrich syndrome manifesting as cutaneous lymphomatoid granulomatosis and responsive to anti-CD20 immunotherapy. J Clin Pathol 2003; 56:555.
6. Costiniuk CT, Karamchandani J, Bessissow A, Routy JP, Szabo J, Frenette C. Angiocentric lymph proliferative disorder (lymphomatoid granulomatosis) in a person with newly-diagnosed HIV infection: a case report. BMC Infect Dis 2018; 18:210.
7. Roschewski M, Wilson WH. Lymphomatoid granulomatosis. Cancer J 2012; 18:469.
8. Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood 2013; 122:1712.
9. Barsam SJ, Patel R, Arya R. Anticoagulation for prevention and treatment of cancer-related venous thromboembolism. Br J Haematol 2013; 161:764.
10. Sood A, Parihar AS, Malhotra P, Vaiphei K, Kumar R, Singh H et al. Pulmonary Recurrence of Lymphomatoid Granulomatosis Diagnosed on F-18 FDG PET/CT. Indian J Nucl Med. 2020;35:167‐169.
11. Gitelson E, Al-Saleem T, Smith MR. Review: lymphomatoid granulomatosis: challenges in diagnosis and treatment. Clin Adv Hematol Oncol 2009;7:68–70
12. Gómez-Hernández MT, Rodríguez-Pérez M, Novoa-Valentín N, Jiménez-López M, Aranda-Alcaide JL, Varela-Simó G. Prevalence of venous thromboembolism in elective thoracic surgery. Arch Bronconeumol. 2013;49:297.
13. Kalweit G, Huwer H, Volkmer I, Petzold T, Gams E. Pulmonary embolism: a frequent cause of acute fatality after lung resection. Eur J Cardiothorac Surg. 1996;10:242