The University of Toledo Translation Journal of Medical Sciences 
Pulmonology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e2 

Rare Case of Mantle Cell Lymphoma 
Presented as Malignant Pleural Effusion 
and Pleural Nodules 
Zaid Noori, MD1*, Mohamed Omballi, MD1

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: zaid.noori@utoledo.edu

Published: 05 May 2023 

Introduction: Mantle cell lymphoma is a relatively uncommon type of B cell non-Hodgkin lymphomas 
(NHL), it comprises about 7 percent of adult NHL in the United States and Europe with an incidence of 
approximately 4 to 8 cases per million persons per year. Most patients have advanced stage disease at 
diagnosis, presenting with lymphadenopathy, with only 25 percent present as extranodal disease such as 
gastrointestinal tract, breast, and orbit. Pleural involvement reported only in about one percent of cases. 

Case Presentation: 53 year old male with past medical history of obesity and hypertension presented to 
the hospital with two weeks history of flank pain and shortness of breath. Chest X-ray revealed left sided 
pleural efusion. Computed tomography (CT) of the chest confirmed the efusion and also showed nodular 
pleural thickening. Computed tomography (CT) of the abdomen and pelvis showed left renal mass and 
multiple soft tissue masses with one measuring up to 4.5 cm on the right flank. Pleural fluid that was 
obtained by thoracentesis was noted to be bloody and exudative (LDH: 750 Units/L, Protein 4.7 g/dL, 
Glucose 12 mg/dL, Lymphocytes 70%). The cytology result of the pleural fluid was consistent with 
lymphoma. Medical thoracoscopy was done which demonstrated pleural nodularity and adhesions. 
Multiple pleural biopsies were obtained. Neoplastic cells obtained from the pleural biopsies stained 
positively for CD20, CD5, and CD10, cyclin D1 and SOX11. Cytogenetic FISH evaluation completed 
on the pleural fluid revealed an IgH/CCND1 variant translocation, and TP53. Simultaneously, the 
neoplastic cells identified within the biopsies taken from the left renal mass and right flank soft tissue 
mass were similar in histomorphology to the neoplasm identified in the pleural samples. Cerebrospinal 
fluid flow cytometry was consistent with central nervous system involvement. All the 
immunophenotypic and cytogenetic findings were consistent with a mantle cell lymphoma. Treatment 
plan included Cytarabine, Methotrexate, and CAR T-Cell therapy.  

Discussion: Although pleural involvement is not uncommon in many types of lymphoma, it is rarely 
reported to be involved in mantle cell lymphoma which is on its own considered a rare form of B-cell 
non-Hodgkin lymphomas (NHL). We report a case of advanced stage lymphoma presented with 
malignant pleural efusion and direct involvement of the pleural space. The main treatment modality 

https://dx.doi.org/10.46570/utjms.vol11-2023-781 

https://dx.doi.org/10.46570/utjms.vol11-2023-781
mailto:zaid.noori@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-781 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-781 2 ©2023 UTJMS 

consist of combination chemotherapy plus immunotherapy (ie, chemoimmunotherapy) with or without 
high dose therapy and hematopoietic cell transplantation (HCT). 

https://dx.doi.org/10.46570/utjms.vol11-2023-781
https://dx.doi.org/10.46570/utjms.vol11-2023-781