T-cell lymphoblastic lymphoma

Aarthi1* Mercy,2 Sri Preethi3, Jaya Menon4

1Staff Nurse, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

2Nursing Incharge , Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

3Nurse Educator , Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

4Nursing Superintendent, Kauvery Hospital, Heartcity, Trichy, Tamil Nadu

*Correspondence

Abstract

T-cell lymphoblastic lymphoma is a rare aggressive neoplasm of precursor T-cells that occurs mainly in adolescents and young adults. We report a 21-year-old female with diagnosed respiratory distress, who was found to have pleural effusion and pericardial effusion. Patients presented with complaints of dyspnea, tachycardia and tachypnea. Echocardiogram revealed moderate pericardial effusion with tamponade. Pigtail was inserted through the subxiphoid region and drained 200 ml of pericardial fluid. Pericardial fluid analysis revealed T-cell lymphoblastic lymphoma. This case report highlights the importance of early identification and understanding treatment options to improve patient prognosis.

Keywords: T-cell lymphoblastic lymphoma; Respiratory distress; Pericardial effusion; Pleural effusion Pericardiocentesis; Pericardial fluid analysis; Cardiac tamponade

Introduction

T-cell lymphoblastic lymphoma is a rare, highly aggressive subtype of non-Hodgkin lymphoma that originates from immature T-lymphoblasts (T-lymphocytes). It usually arises in the thymus and commonly affects children, adolescents, and young adults. Although it grows rapidly, it is potentially curable with intensive chemotherapy.

Case presentation

Patient: 21-year-old female.

Presentation

  • Breathlessness
  • Tachycardia
  • Tachypnea
  • Pleural effusion
  • Pericardial effusion

Findings

  • Echocardiogram showed moderate pericardial effusion with cardiac tamponade.
  • Emergency pigtail drainage was performed.
  • Approximately 240 mL of pericardial fluid was drained.

Diagnosis: Pericardial fluid analysis confirmed T-cell lymphoblastic lymphoma

Clinical Examination

On Examination

  • Patient conscious and oriented.
  • Clinical Examination
  • Pulse: 114 bpm,Blood Pressure: 100/60 mmHg
  • CVS: S1, S2 +
  • RS: BAE + (Bilateral Air Entry Present)
  • PA: Soft +
  • CNS: Within normal limits.

Investigations

  • Laboratory analysis of pericardial fluid showed elevated ADA and LDH .
  • PET-CT revealed a metabolically active, ill-defined, heterogeneous, mildly enhancing soft tissue density mass in the anterior mediastinum towards the right side, likely representing thymic lymphoma.
  • Bone marrow biopsy showed no definite morphological evidence of bone marrow involvement by lymphoma.

Lab Investigation

S.NoInvestigation NameResult
1Protein Fluid4.5 g/dl
2Fluid For Sugar<20.0
3LDH Fluid11527 U/L
4ADA (Body Fluid)1854.8 (Pericardial fluid) U/L
5Glucose in Glucometer POCT108 mg/dL
6Potassium3.6 mmol/L
7Bicarbonate25 mEq/L
8Chloride107 mmol/L
9Sodium137 mmol/L
10Creatinine0.5 mg/dL
11Urea Serum14 mg/dL
12LDH - Serum620 U/L
13Calcium Serum8.2 mg/dL
14Uric Acid5.8 mg/dL
15Phosphorous2.5 mg/dL
16Glucose in Glucometer POCT115 mg/dL
17Platelet Count337000 Cells/Cumm
18Haemoglobin13.1 g/dl
19Total WBC Count8900 Cells/Cumm

Other investigations

Bone Marrow Aspirate and biopsy report and 18F-FDG PET/CT Report

Impression

  • Metabolically active ill-defined heterogeneously mildly enhancing soft tissue density mass in the anterior mediastinum toward the right side as described above. Likely represents thymic lymphoma.
  • Multiple enlarged metabolically active lymph nodes in the mediastinum – likely disease involvement.
  • Metabolically active diffuse pleural thickening involving entire right lung – similar to pleura, concerning for disease involvement.
  • Trace right-sided pleural effusion and mild pericardial effusion.
  • A prominent low-grade metabolically active lymph node in the right supraclavicular region of significance.
  • No other metabolically active visceral or skeletal lesions.

Management

Medical Management: Treatment follows Acute Lymphoblastic Leukemia (ALL) protocols.

Common Drugs:

  • Vincristine
  • Prednisolone
  • Cyclophosphamide
  • Methotrexate
  • Dexamethasone
  • Daunorubicin
  • Cytarabine

Additional Therapy

  • Radiation therapy
  • Hematopoietic stem cell transplantation

Nursing Management

  • Implement infection prevention measures.
  • Provide nutritional support.
  • Manage pain and fatigue.
  • Educate the patient and family regarding the disease, treatment, medications, and follow-up care.
  • Offer psychological and emotional support.

Conclusion

This case report highlights the importance of early identification and prompt treatment with chemotherapy in T-cell lymphoblastic lymphoma. Accurate diagnosis, risk-adapted therapy, vigilant supportive care, and long-term follow-up are essential for achieving favorable clinical outcomes.

References

  1. Kaushansky K, Lichtman MA, Prchal JT, Levi MM, Press OW, Burns LJ (Eds.). Williams Hematology, 10th Edition. McGraw-Hill; 2021. Page No.: 1810.
  2. Alaggio R, Amador C, Anagnostopoulos I, et al. (2022). The 5th Edition of the World Health Organization Classification of Haemato lymphoid Tumors: Lymphoid Neoplasms. Leukemia, 36(7), 1720–1748. Page No.: 1720–1722.
  3. International Consensus Classification (ICC), Dorfman DM, Mullighan CG, Borowitz MJ, et al. (2022). International Consensus Classification of Acute Lymphoblastic Leukemia/Lymphoma. Virchows Archiv, 482(1),

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