Background. Primary pulmonary malignant lymphomas account for 0.5% to 1% of all primary pulmonary malignancies, with B-cell lymphomas accounting for 70% to 80% and T-cell lymphomas being rare. Case. An elderly woman in her 80s was referred to our hospital for further examination and treatment due to a consolidation in the left upper lung field on chest X-ray. Contrast-enhanced computed tomography revealed a mass integrated with lymph nodes in the left upper lobe as well as enlarged lymph nodes in the subtracheal bifurcation, contralateral hilar lymph node, and peripancreatic lymph node. A transbronchial biopsy of the left upper lobe was performed, and histopathological findings showed numerous small lymphocytic infiltrates in the interstitial lung. Immunostaining revealed CD3 (+), CD4 (+), CD8 (-), and CD20 (-), leading to a diagnosis of T-cell lymphoma. The patient tested positive for human T-cell leukemia virus type-1 (HTLV-1) antibodies, raising suspicion of adult T-cell leukemia-lymphoma (ATL). However, HTLV-1 proviral DNA was not detected in the biopsy tissue. The patient was subsequently referred to the hematology department of another hospital, where left pleural effusion was identified. ATL cells were detected in the effusion, confirming the diagnosis of lymphoma-type ATL. The patient showed a positive response to cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) therapy. Conclusion. Lymphoma-type ATL has a poor prognosis. A prompt diagnosis was achieved in this case through bronchoscopy, enabling the timely initiation of treatment.
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