T-cell lymphoma with a granulomatous lesion of the lungs after autologous hematopoietic stem cell transplantation against Epstein–Barr virus-positive diffuse large B-cell lymphoma: a case report

Background Post-transplant lymphoproliferative disorders (PTLDs) are serious lymphoid and/or plasmacytic proliferations that occur after undergoing solid organ or hematopoietic stem cell transplantation (HSCT). In the context of HSCT, most reported PTLDs have occurred in patients who received allogenic HSCT (AlloHSCT), but only a few cases have been reported in autologous HSCT (AHSCT) recipients. Primary pulmonary T-cell lymphoma cases are also rare and have been reported mostly in case studies. Case presentation: A 53-year-old female patient initially presented with enlargement of the left cervical lymph nodes and was diagnosed as Epstein–Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL). She was treated with R-CHOP, R-ACES, and autologous HSCT (AHSCT) and went into remission. Four years later, computed tomography results revealed multiple lung nodules, and abnormal infiltration and sustained and progressing hypogammaglobulinemia was observed. The pathological specimen of video-assisted thoracoscopic surgical lung biopsy demonstrated extensive invasion of lymphocytes with notable granuloma findings. Flow cytometric immunophenotyping analysis showed that lymphocytes were positive for CD3 and CD5; especially, CD3 was expressed in the cytoplasm. Southern blot analysis revealed rearrangements of the T-cell receptor Cβ1 gene. She was diagnosed with peripheral T-cell lymphoma, regarded as T-cell PTLD accompanied by granulomatous lesion. Conclusion Here, we report a rare case of T-cell lymphoma that mainly affected the lungs with the presentation of notable granulomatous findings following AHSCT against EBV-positive DLBCL. This uncommon presentation of rare lung lesions of granulomatous T-cell lymphoma could be related to the manifestation of a PTLD associated with sustained hypogammaglobulinemia.