PMC4061434_01
Chest radiograph of an 18-year-old boy who presented with cough and tachypnea demonstrates a large anterior mediastinal mass and a left pleural effusion with a light contralateral shift of the trachea and mediastinum. Aspiration of the effusion and biopsy of the parietal pleura provided the diagnosis of lymphoblastic lymphoma.
gr1.jpg
PMC4061434_01_gr1.jpg
fig1
Chest X-ray demonstrates a large anterior mediastinal mass and a left pleural effusion with a light contralateral shift of the trachea and mediastinum (Fig. 1).
Chest computed tomography view of the patient. Chest CT showed left-sided pleural effusion, an anterior and middle mediastinal mass (B, D, F, white arrow) which resulted in contralateral shift and stricture of the tracheal (A, black arrow) and left mainstem bronchus stricture (C, black arrow). Chest CT at the level of heart demonstrating pleural thickening of the left hemithorax, left-sided pleural effusion and a light pericardial effusion (E, F).
gr2.jpg
PMC4061434_01_gr2.jpg
fig2
Chest computed tomography (CT) showed an anterior and middle mediastinal mass with a light contralateral shift of the trachea, pleural thickening of the left hemithorax, and left-sided pleural effusion (Fig. 2).
Thoracoscopy view of patient. The inspection of the pleural by a direct vision optic revealed massive bloody pleural fluid in the pleural cavity, and widely irregular thickening with lots of small white apophysis involving the parietal pleura.
gr3.jpg
PMC4061434_01_gr3.jpg
fig3
The inspection of the pleural by a direct vision optic revealed massive bloody pleural fluid in the pleural cavity, and widely membrane hyperemia with lots of small white apophysis involving the parietal pleura (Fig. 3).
Hispathological examination of the parietal pleural biopsies after medical thoracoscopy. (A) Parietal pleural infiltrated by monotonous small lymphoid cells with scantly cytoplasm and slightly irregular, round oval nuclei, and dense chromatin (hematoxylin and eosin staining, original magnification x400). (B) CD3 immunoreactivity in parietal pleura infiltrates (original magnification x400). (C) TdT immunoreactivity in parietal pleura infiltrates (original magnification x400). (D) CD99 immunoreactivity in parietal pleura infiltrates (original magnification x400). (E) staining shows negative reaction for B-cell marker in parietal pleural infiltrates (original magnification x400). (F) Ki67 immunoreactivity in parietal pleura infiltrates (original magnification x400).
gr4.jpg
PMC4061434_01_gr4.jpg
fig4
The immunohistochemical analysis of lymphoma cells showed CD20 (-), CD3 (+), CD21 (residual FDC+), Ki67 (30%+), terminal deoxynucleotidyl transferase (TdT, +), CD99(+), which was consistent with T-cell lymphoblastic lymphoma (Fig. 4).
PMC4061434_02