326
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S-565￭
Primary Effusion Lymphoma-Like Lymphoma presenting with Cardiac Tamponade
1서울대학교병원 내과, 2중앙대학교병원 내과, 3강원대학교병원 병리과, 4분당서울대학교병원, 서울대학교 의과대학 내과학교실
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김현지
1, 김희준
2, 이경열
3, 윤창환
4, 방수미
4, 강시혁
4Primary effusion lymphoma (PEL) is a rare type of lymphoma that presents as lymphomatous effusion in body cavities with neither detectable mass nor lymphadenopathy. While PEL is predominantly related to the immunosuppressed patients infected with human herpesvirus 8 (HHV-8), PEL-like lym- phoma is negative for HHV-8. Here, we report a 73-year-old men with HHV-related PEL-like lymphoma. He presented with dyspnea on exertion with a one-week duration. Echocardiography showed pericardial effusion with tamponade physiology. Cytology revealed cellular population compatible with diffuse large B cell lymphoma. Stainings for HHV-8 by immunohistochemistry by in situ hybridization were negative. The patient’s serology was also negative for HHV-8. Thorough evaluation including CT, whole body PET-CT, esophagogastroduodenoscopy, colonoscopy, and the bone marrow biopsy showed no evidence of malignancy. Despite systemic chemotherapy, the patient died only after three months. This is a rare case of PEL-like lymphoma in immunocompetent patient with poor prognosis.
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S-566￭
A case of patient with multiple myeloma presenting as ascites, pleural and pericardial effusion
안양샘병원 내과
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김종욱, 고두현, 김태형, 최진호
Multiple myeloma (MM) is known that it could involve extramedullary organs. But, pleural effusion occurs in only 6% of MM. Ascites and pericardial effusion were described in only a few cases of MM. Here, we report a case of MM with various manifestations. A 85-year-old woman presenting with dizziness admitted to hospital. Before admission, she received abdominal CT and endoscopy to evaluate the cause of anemia. Ascites, pleural effusion and pericardial effusion were observed in CT, but there was no gastrointestinal bleeding. Other symptoms were dyspnea and abdominal discomfort. On physical examination, pale conjunctiva and distended abdomen were shown. Laboratory tests were as follows: Hg 7.0 g/dL, BUN 35 mg/dL, Cr 1.2 mg/dL, IgG 3,480 mg/dL, free Kappa light chain 161mg/L, beta 2-microglobulin 8.61mg/L. Urine and serum PEP showed M-component, serum IFE showed monoclonal gammopathy of IgG Kappa type. Bone marrow aspiration revealed infiltration of plasma cell counted up to 41.1%. Chemotherapy with melphalan, prednisolone and bortezomib was started. After 3months, follow up CT was done and existing ascites, pleural and pericardial effusion were resolved. Serum M-protein decreased from 2.83 g/dL to 1.39 g/dL after chemotherapy and that of urine decreased from 82.3 mg/day to 30.0 mg/day, which was a partial response. Also patient’s symptoms were improved. Extramedullary complication of MM is uncommon and is usually un- responsive to therapy. This is a case of patient who shows a good response to chemotherapy, in spite of several extramedullary complications.
