Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 51-year-old previously healthy man, an ex-smoker, was admitted to the authors' medical department with a 3-month history of dry cough; intermittent fever; painless, ulcerated cutaneous lesions over the trunk and limbs (Figure 1); and progressive weight loss. He was of Greek descent. His medical history was remarkable for nasal polyps, which were surgically removed 15 years earlier. Initially, he had been treated with antibiotics, without improvement. Several days before admission, chest radiography revealed pulmonary infiltrates in the left lower lobe. On admission, physical examination revealed a well-orientated man in mild distress, with inspiratory rhonchi at the lower part of the left lung and scattered erythematous nodules of variable size, some of which were ulcerated. Laboratory values were notable for leukopenia, 3.3 x 10(9)/L; total protein, 5.9 g/dL; globulin, 2.2 g/dL; serum glutamic oxaloacetic transaminase, 86 IU/L; serum glutamic pyruvic transaminase, 71 IU/L; and lactate dehydrogenase, 519 U/L. Computed tomograph (CT) of the chest showed multiple alveolar opacities bilaterally (Figure 2). Fiberoptic bronchoscopy did not reveal any important pathologic findings. Results of bronchial biopsy, cytology of bronchoalveolar lavage, washing, brushing, and sputum following bronchoscopy were negative. CT of the brai and sinonasal area revealed an abnormal low-density mass in the left nasal area. CT findings of the abdomen were negative, as were results of a bone marrow biopsy. There was no evidence of immunosuppression. The differential diagnosis, considering the evidence described, included granulomatous or infectious diseases, angiocentric lymphoproliferative lesions, and lymphomas. Biopsy of a skin lesion showed lymphoproliferative infiltration of the dermis with a follicular and angiocentric growth pattern and regional epidermal necrosis. Immunohistochemical stains showed that the tumor cell were positive for CD56 and CD3 (cytoplasmic positivity) and expressed the cytotoxic proteins T-cell intracellular antigen and granzyme B (Figure 3) They lacked TdT, CD34, CD7, CD8, TCL-1, and CD123. Findings from an in situ hybridization study for Epstein-Barr virus were negative. Give this result, molecular analysis ofT-cell receptor (TCR) gene rearrangements was performed using polymerase chain reaction-based TCR-gamma gene, wit negative results. The morphology and the immunophenotype were consistent with natural killer/T-cell lymphoma, nasal-type. Nasal involvement must be first excluded to proceed to the diagnosis of nasal-type natural killer-cell lymphoma. Indeed, histologic examination of the nasal mass revealed its polypoid nature. Thus, the authors were led to the diagnosis of extranodal extranasal natural killer/T-cell lymphoma, nasal-type, CD56-positive, Ep stein-Barr virus-negative, TCR-negative. The patient received combination chemotherapy and completed 4 cycles of cyclophosphamide, doxorubicin vincristine, and prednisone every 14 days for 2 months. Skin lesions improved, and there was no fever soon after the initiation of therapy. Reevaluatio after the fourth cycle, however, disclosed pulmonary infiltrations as well as leukemic infiltration of the central nervous system. The patient had receive systemic salvage chemotherapy and intrathecal infusions of methotrexate. Although the lung lesions had diminished at that time, the patient develope paraplegia, his clinical course rapidly deteriorated, and he eventually died.
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PMID:Extranodal natural killer/T-cell lymphoma, nasal-type. 2083 28

The estimated prevalence of extranodal non-Hodgkin lymphoma ranges from 10 to 35% of all cases; a finding in the larynx is extremely rare. We describe the case of a 77-year-old man who presented for evaluation of a 1-month history of minor swallowing difficulty, cough, and a foreign-body sensation in the throat. Fiberoptic endoscopy detected a tumor mass on the left aryepiglottic fold. Vocal fold mobility was normal. A biopsy specimen was obtained, and microscopic analysis revealed that the stratified squamous epithelium was partially eroded by abundant infiltrate that had occupied the entire submucosa. The submucosal infiltration consisted of lymphatic cells, including small, medium-sized, and large cells with an anaplastic appearance. On immunohistochemical analysis, the lymphoma cell population stained positive for CD3 and CD2, focally positive for CD56, and negative for CD4, CD5, and CD7. In addition, tumor cells expressed TIA-1, perforin, and granzyme B. A complete radiologic, pulmonologic, and hematologic workup found no other tumor. The patient underwent two cycles of chemotherapy followed by radiotherapy, and he experienced complete tumor regression. At the 1-year follow-up, findings on fiberoptic endoscopy of the larynx were normal, and positron-emission tomography found no evidence of a recurrence. The prognosis for this type of tumor is good when the diagnosis is made in the early phase of the disease. Long-term follow-up is advisable for the timely detection of possible local or distant recurrences, which are common.
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PMID:Primary laryngeal NK/T-cell non-Hodgkin lymphoma: a case report. 2282 38

Sarcomatoid variant of anaplastic large cell lymphoma (ALCL) is one of the rarest histologic variants of ALCL that consists of large, bizarre, often spindle-shaped, neoplastic cells resembling a soft tissue sarcoma. We report here such a case of ALCL with both pulmonary and multiple nodal involvement in a 47-year-old woman who initially presented with fever, cough, sputum, itching skin, and weight loss. The initial transbronchial lung biopsy showed discohesive pleomorphic malignant cells in a strong inflammatory milieu reminiscent of inflammatory malignant fibrous histiocytoma (MFH). Subsequent cervical lymph node biopsy revealed a spindle cell sarcoma predominantly composed of plump spindle and oval neoplastic cells in interweaving fascicles, with sparse inflammatory infiltrates, resembling pleomorphic-storiform type of MFH. However, these tumor cells in the lung and node lesions revealed essentially similar immunohistochemical features that were positive for CD30, EMA, TIA-1, granzyme B, and fascin, but negative for anaplastic lymphoma kinase (ALK), and T- or B-lineage-specific marker. The spindled cells stains diffuse strong positive for smooth muscle actin (SMA), along with vimentin. Further studies showed that the tumor produced large quantities of the proinflammatory cytokines interleukin-2 (IL-2), IL-6, and IL-8, which we believe may contribute to the pathogenesis of sarcomatoid transformation of this tumor, and was associated with the patient's inflammatory symptoms. To the best of our knowledge, this is the first reported case of sarcomatoid variant of ALK-negative ALCL with null cell phenotype and in situ production of proinflammatory cytokines presenting as multiple nodes and pulmonary involvement.
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PMID:Sarcomatoid variant of ALK- anaplastic large cell lymphoma involving multiple lymph nodes and both lungs with production of proinflammatory cytokines: report of a case and review of literature. 2519 51

Primary pulmonary lymphoma, particularly non-B cell lymphomas involving lung parenchyma, is very rare. A 46-year-old male was admitted to the hospital with fever and cough. Chest X-ray showed left lower lobe consolidation, which was considered pneumonia. However, because the patient showed no response to empirical antibiotic therapy, bronchoscopic biopsy was performed for proper diagnosis. The biopsied specimen showed infiltrated atypical lymphocytes with angiocentric appearance. On immunohistochemical staining, these atypical cells were positive for CD3, CD30, CD56, MUM-1, and granzyme B, and labeled for Epstein-Barr virus encoded RNA in situ hybridization. These findings were consistent with NK/T cell lymphoma. We report on a case of primary pulmonary NK/T cell lymphoma presenting as pneumonic symptoms and review the literature on the subject.
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PMID:A case of primary pulmonary NK/T cell lymphoma presenting as pneumonia. 2714 31