关键词: Angioimmunoblastic T-cell lymphoma (AITL) disseminated intravascular coagulopathy (DIC) paraneoplastic syndromes (PS) syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Mesh : Aged Biopsy Bone Marrow / metabolism pathology Female Humans Immunoblastic Lymphadenopathy / pathology Immunohistochemistry Lymphoma, T-Cell, Peripheral / diagnosis pathology Male Paraneoplastic Syndromes / diagnosis pathology Positron-Emission Tomography Spleen / metabolism pathology

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Abstract:
BACKGROUND: Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive subtype of peripheral T-cell lymphoma with unique clinical, pathological and genetic features. Clinical diagnosis is often hampered as typical lymphoma-associated symptoms may not be found at the time of first presentation and only occur later during disease progression. However, as AITL leads to a de-regulated immune system, various paraneoplastic syndromes or autoimmune reactions may represent the first clinical signs, resulting in delayed diagnosis and treatment.
METHODS: We herein describe two AITL cases characterized by a fatal clinical course and the occurrence of unusual paraneoplastic phenomena, including fluid retention and disseminated intravascular coagulation, respectively. Despite multiple diagnostic procedures, both patients died of rapid disease progression and definitive diagnoses could only be established post-mortem.
CONCLUSIONS: These cases underscore the complex diagnostic challenges of AITL and illustrate the requirement for careful clinical evaluation and prompt integration of different diagnostic parameters, including immunohistochemistry, flow cytometry, conventional cytogenetics and molecular genetics, to enable adequate and prompt therapeutic interventions.
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