TIA-1+ cytotoxic large T-cell lymphoma of the mediastinum: Case report

A 52‐year‐old previously healthy Caucasian woman presented with superior vena cava syndrome, secondary to compression of a bulky anterior mediastinal mass involving the right lung. Fine‐needle aspiration biopsy of the mediastinum yielded large epithelioid cells intermingled with small mature lymphocytes. The epithelioid cells are LCA positive, expressing cytoplasmic CD3 diffusely and TIA‐1 focally, but negative for EMA, CD4, CD8, CD15, CD20, CD30, and CD56. The TIA‐1+ cytoplasmic granules correlated to the azurophilic granules in Diff‐Quik‐stained cells, pink granules in Ultrafast Papanicolaou‐stained cells, and dense core granules in electron microscopy. In situ hybridization for Epstein‐Barr viral RNA was negative. The background small lymphocytes were composed of a majority of CD4+ T‐lymphocytes and minority of CD8+ T‐lymphocytes. The patient responded well to six cycles of CHOP chemotherapy, followed by radiation with a total dose of 4140 cGy delivered to the mediastinum in 23 fractions. On the chest X‐ray taken 6 mo later, there was minimal apical fibrosis with no evidence of an acute intrathoracic pathology. To the best of our knowledge, this case may be the first report of cytotoxic large T‐cell lymphoma of the mediastinum. Diagn. Cytopathol. 2002;26:154–157; DOI 10.1002/dc.10050 © 2002 Wiley‐Liss, Inc.