Beyond Lineage Boundaries: Concurrent Acute Myeloid Leukemia and T-cell Lymphoblastic Lymphoma in a Filipino Patient
Materials and Methods/Case Presentation/Objective:
A 49-year-old Filipino male presented with a three-month history of progressive back pain, generalized weakness, and constitutional symptoms. Initial evaluation revealed anemia, thrombocytopenia, and bone marrow findings consistent with AML. Imaging incidentally demonstrated a 7.5 × 5.6 × 2.7 cm anterior mediastinal mass. Upon transfer to our institution, he had persistent cytopenia, 21% circulating blasts, acute kidney injury, severe hypercalcemia requiring hemodialysis, and cranial nerve VI palsy suggestive of central nervous system involvement. Given the atypical presence of a large mediastinal mass, tissue biopsy was performed before chemotherapy. Histopathology and immunohistochemistry confirmed T-cell lymphoblastic lymphoma. His hospital course was complicated by massive post-biopsy hemothorax due to tumoral bleeding, resulting in refractory hypovolemic shock and death.
Results/Description/Main Outcome Measure(s):
Conclusion(s).:
This case underscores the importance of tissue diagnosis when clinical or radiologic findings are atypical, as synchronous hematologic malignancies may significantly alter diagnosis, management and prognosis. It also highlights the value of a multidisciplinary approach in rare hematologic neoplasms and expands the literature by documenting the first reported synchronous AML and T-LBL case from the Philippines.
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