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PO-0271 A Difficult Diagnosis Of Natural Killer Cell Lymphoma Presenting With Bilateral Pleural Effusions
  1. A Meral1,
  2. S Kesici2,
  3. M Tanyildiz2,
  4. Z Akcoren3,
  5. B Aydin4,
  6. A Birbilen1,
  7. B Bayrakci2
  1. 1Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
  2. 2Department of Pediatrics Division of Pediatric Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
  3. 3Department of Pediatrics Division of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
  4. 4Department of Pediatrics Division of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Abstract

Background Natural killer (NK) cell lymphoma is a rare and aggressive neoplasm characterised by angioinvasion or angiodestruction. The aim of this report to describe a patient with an aggressive neoplasm with poor prognosis which might be of interest for the clinicians.

Case presentation We herein report a case of a 14-year-old girl suffering from cough and back pain for one week. Computerised tomography showed bilateral pleural effusions and mediastinal axillary lymph nodes. The specimen from pleural effusion showed a transudate character with no tuberculosis or no sign of malignancy. Because of increasing dyspnea, a chest tube was inserted and pleural and lung parenchyma biopsy was performed and no definite diagnosis was done. After two weeks, chest tube was drawn. 4 days later, the patient admitted to our emergency room with dyspnea and back pain. Because of increased pleural effusion, the patient was intubated immediately and was referred to paediatric intensive care unit. Detailed diagnostics tests showed anaemia, thrombocytopenia, hypoechoic lesions on spleen and liver, intraabdominal multiple lymph nodes, sclerotic lesions on vertebrae. A tru-cut biopsy was performed by interventional radiology and malignant infiltration was reported. Chemotherapy was initiated to the patient however, the patient’s status was altered and died.

Conclusion We present a case of primary pulmonary NK cell lymphoma. The course of the disease was fulminant although the patient received aggressive chemotherapy and other symptomatic treatments. Our case who had difficulty in diagnosis may help to clinicians to identify other cases with NK cell lymphoma, their treatment and outcomes.

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