Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
권호 표지
DOI QR코드

DOI QR Code

Anaplastic large cell lymphoma with marked peripheral eosinophilia misdiagnosed as Kimura disease

기무라병으로 오진된, 말초혈액 호산구증가증을 동반한 역형성대세포림프종

  • Shin, Yoonji (Department of Internal Medicine, Korea University College of Medicine) ;
  • Oh, Jee Youn (Department of Internal Medicine, Korea University College of Medicine) ;
  • Lee, Young Seok (Department of Internal Medicine, Korea University College of Medicine) ;
  • Min, Kyung Hoon (Department of Internal Medicine, Korea University College of Medicine) ;
  • Lee, Sung Yong (Department of Internal Medicine, Korea University College of Medicine) ;
  • Shim, Jae Jeong (Department of Internal Medicine, Korea University College of Medicine) ;
  • Kang, Kyung Ho (Department of Internal Medicine, Korea University College of Medicine) ;
  • Hur, Gyu Young (Department of Internal Medicine, Korea University College of Medicine)
  • 신윤지 (고려대학교 의과대학 내과학교실) ;
  • 오지연 (고려대학교 의과대학 내과학교실) ;
  • 이영석 (고려대학교 의과대학 내과학교실) ;
  • 민경훈 (고려대학교 의과대학 내과학교실) ;
  • 이승룡 (고려대학교 의과대학 내과학교실) ;
  • 심재정 (고려대학교 의과대학 내과학교실) ;
  • 강경호 (고려대학교 의과대학 내과학교실) ;
  • 허규영 (고려대학교 의과대학 내과학교실)
  • Received : 2017.07.10
  • Accepted : 2017.09.29
  • Published : 2018.03.31
⟨ Previous Next ⟩

Abstract

Hypereosinophilia, defined as an absolute eosinophil count of > $1,500/{\mu}L$, can be caused by a number of allergic, infectious, paraneoplastic and neoplastic disorders. In cases of hypereosinophilia with lymphoid proliferation, pathological confirmation is essential to exclude either myeloid or lymphoid malignancy. A 38-year-old woman with both cervical lymphadenopathies and peripheral blood eosinophilia visited our clinic. She had already performed core biopsy of lymph nodes and diagnosed as Kimura disease at a regional hospital. At the time of our clinic visit, there were no palpable cervical lymph nodes. The blood test showed hypereosinophilia with a high total IgE level. There was no evidence of tissue infiltration of eosinophils except for duodenitis with eosinophilic infiltration. Based on these findings, she was diagnosed as Kimura disease. She treated with high-dose systemic corticosteroid (1 mg/kg) and additional immunosuppressants sequentially used cyclophosphamide and cyclosporine. However, her eosinophilia waxed and waned, and a left inguinal mass was newly found. Excisional biopsy findings showed large atypical lymphoid cells with numerous eosinophilis, and immunohistochemistry showed CD3+, CD20-, CD30+ and anaplastic lymphoma kinase (ALK). The final diagnosis was ALK-negative anaplastic large cell lymphoma. We report a case of anaplastic large cell lymphoma with marked peripheral eosinophilia misdiagnosed as Kimura disease. In the case of hypereosinophilia with lymphadenopathy, it is necessary to differentiate hematologic diseases through immunochemical staining.

Keywords

References

  1. Helbig G. Advances in the diagnosis and treatment of eosinophilia. Curr Opin Hematol 2014;21:3-7. https://doi.org/10.1097/MOH.0000000000000011
  2. Gotlib J. World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management. Am J Hematol 2015;90:1077-89. https://doi.org/10.1002/ajh.24196
  3. Sun QF, Xu DZ, Pan SH, Ding JG, Xue ZQ, Miao CS, et al. Kimura disease: review of the literature. Intern Med J 2008;38:668-72. https://doi.org/10.1111/j.1445-5994.2008.01711.x
  4. Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: a clinicopathologic study of 21 cases. Am J Surg Pathol 2004;28:505-13. https://doi.org/10.1097/00000478-200404000-00010
  5. Valent P, Klion AD, Horny HP, Roufosse F, Gotlib J, Weller PF, et al. Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes. J Allergy Clin Immunol 2012; 130:607-12.e9. https://doi.org/10.1016/j.jaci.2012.02.019
  6. Hsieh FH. Hypereosinophilic syndrome. Ann Allergy Asthma Immunol 2014;112:484-8. https://doi.org/10.1016/j.anai.2014.03.004
  7. Park CS, Lee SP. Recent advances in the classification and management of hypereosinophilia. Allergy Asthma Respir Dis 2015;3:387-95. https://doi.org/10.4168/aard.2015.3.6.387
  8. Ogbogu PU, Bochner BS, Butterfield JH, Gleich GJ, Huss-Marp J, Kahn JE, et al. Hypereosinophilic syndrome: a multicenter, retrospective analysis of clinical characteristics and response to therapy. J Allergy Clin Immunol 2009;124:1319-25.e3. https://doi.org/10.1016/j.jaci.2009.09.022
  9. Roche-Lestienne C, Lepers S, Soenen-Cornu V, Kahn JE, Lai JL, Hachulla E, et al. Molecular characterization of the idiopathic hypereosinophilic syndrome (HES) in 35 French patients with normal conventional cytogenetics. Leukemia 2005;19:792-8. https://doi.org/10.1038/sj.leu.2403722
  10. Chihara D, Fanale MA. Management of anaplastic large cell lymphoma. Hematol Oncol Clin North Am 2017;31:209-22. https://doi.org/10.1016/j.hoc.2016.11.001
  11. Mak V, Hamm J, Chhanabhai M, Shenkier T, Klasa R, Sehn LH, et al. Survival of patients with peripheral T-cell lymphoma after first relapse or progression: spectrum of disease and rare long-term survivors. J Clin Oncol 2013;31:1970-6. https://doi.org/10.1200/JCO.2012.44.7524
  12. Takimoto Y, Tanaka H, Tanabe O, Kuramoto A, Sasaki N, Nanba K. Anaplastic large-cell lymphoma (Ki-1 lymphoma) with expression of IL-5 mRNA and eosinophilic invasion. Acta Haematol 1996;96:245-8. https://doi.org/10.1159/000203793
  13. McCluggage WG, Walsh MY, Bharucha H. Anaplastic large cell malignant lymphoma with extensive eosinophilic or neutrophilic infiltration. Histopathology 1998;32:110-5. https://doi.org/10.1046/j.1365-2559.1998.00335.x
  14. McKelvie PA, Oon S, Romas E, Nandurkar H, Tam CS. A case of systemic anaplastic lymphoma kinase-negative anaplastic large cell lymphoma associated with hypereosinophilia, granulomatous myositis and vasculitis. Leuk Lymphoma 2012;53:2279-82. https://doi.org/10.3109/10428194.2012.677592
  15. Powers ML, Watson BW, Frater JL, Kreisel F, Hassan A. Peripheral eosinophilia camouflaging anaplastic large cell lymphoma. Int J Surg Pathol 2011;19:405-8. https://doi.org/10.1177/1066896908323969
  16. Orofino N, Guidotti F, Cattaneo D, Sciume M, Gianelli U, Cortelezzi A, et al. Marked eosinophilia as initial presentation of breast implant-associated anaplastic large cell lymphoma. Leuk Lymphoma 2016;57:2712-5. https://doi.org/10.3109/10428194.2016.1160079
  17. Duval A, Bergoin E, Maynadie M, Bonnotte B, Girodon F. Images in haematology. Hypereosinophilia as a presenting feature of anaplastic large cell lymphoma. Br J Haematol 2008;140:363. https://doi.org/10.1111/j.1365-2141.2007.06836.x
  18. Choi W, Park YH, Paik KH, Chang YH, Lee SS, Ryoo BY, et al. Peripheral T-cell lymphoma-unspecified (PTCL-U) presenting with hypereosinophilic syndrome and pleural effusions. Korean J Intern Med 2006;21:57-61. https://doi.org/10.3904/kjim.2006.21.1.57
  19. Kim CJ, Park SH, Chi JG. Idiopathic hypereosinophilic syndrome terminating as disseminated T-cell lymphoma. Cancer 1991;67:1064-9. https://doi.org/10.1002/1097-0142(19910215)67:4<1064::AID-CNCR2820670433>3.0.CO;2-P
  20. Koh YI. Clinical characteristics of Kimura's disease. Korean J Asthma Allergy Clin Immunol 2010;30:275-6.