{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:47:52Z","timestamp":1777042072811,"version":"3.51.4"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lymphoblastic lymphoma is a rare type of malignant lymphoma. B-lymphoblastic lymphoma with pleural effusion as the initial manifestation is extremely rare; in this study, we report a specific and challenging diagnostic process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present the case of a 67-year-old woman who was initially diagnosed with tuberculous pleurisy with a right pleural effusion. The pleural effusion was an exudate composed primarily of mononuclear cells with elevated adenosine deaminase (ADA) and lactate dehydrogenase (LDH). The cytological results of the pleural effusion were negative. The contrast-enhanced CT suggested right pleural nodules with partial pleural thickening. Subsequently, a CT-guided percutaneous needle pleural biopsy was performed, and pathological consultation, bone marrow biopsy, and flow cytology examination were carried out. Finally, B-lymphoblastic lymphoma was diagnosed. During a recent follow-up, the patient showed signs of improvement nearly without pleural effusion after chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Malignant pleural effusion caused by lymphoma can be easily misdiagnosed as tuberculous pleurisy, as both conditions commonly show markedly elevated levels of ADA and LDH. Flow cytology examination of pleural fluid can be considered, and histological specimens should be actively obtained to clarify the pathological diagnosis. For patients with extensive pleural thickening, a CT-guided percutaneous pleural biopsy can be preferentially selected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1619612","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T05:20:21Z","timestamp":1765948821000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Rare pleural effusion\u2014a case of B-lymphoblastic lymphoma presenting with pleural effusion and diagnostic challenges"],"prefix":"10.3389","volume":"12","author":[{"given":"Fang","family":"Lu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenkang","family":"Zong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liheng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongrui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Jia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.3760\/cma.j.cn112147-20230902-00126","article-title":"Chinese expert consensus on treatment of malignant pleural effusion (2023 edition)","volume":"46","year":"2023","journal-title":"Chin J Tuberc Respir Dis"},{"key":"ref2","first-page":"5953","article-title":"Clinical characteristics of newly diagnosed non-Hodgkin lymphoma with initial presentation of serous cavity effusion","volume":"42","author":"Qu","year":"2022","journal-title":"Chin J Gerontol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"373","DOI":"10.21037\/atm.2019.07.17","article-title":"Differential diagnosis between lymphoma-associated malignant pleural effusion and tuberculous pleural effusion","volume":"7","author":"Kim","year":"2019","journal-title":"Ann Transl Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11912-021-01168-x","article-title":"Lymphoblastic lymphoma: a concise review","volume":"24","author":"Intermesoli","year":"2022","journal-title":"Curr Oncol Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.3892\/mmr.2019.10451","article-title":"miR-338-3p suppresses the malignancy of T-cell lymphoblastic lymphoma by downregulating HOXA3","volume":"20","author":"Wang","year":"2019","journal-title":"Mol Med Rep"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"724","DOI":"10.3390\/hematolrep16040069","article-title":"A case of B-cell lymphoblastic lymphoma presenting with an isolated epidural mass treated successfully with radiotherapy followed by United Kingdom acute lymphoblastic Leukemia (UKALL) chemotherapy protocol","volume":"16","author":"Alzahrani","year":"2024","journal-title":"Hematol Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1111\/cyt.12515","article-title":"Forty-nine cases of acute lymphoblastic leukaemia\/lymphoma in pleural and pericardial effusions: a cytological-histological correlation","volume":"29","author":"Li","year":"2017","journal-title":"Cytopathology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1148\/radiographics.21.1.g01ja02161","article-title":"Extranodal Hodgkin disease: spectrum of disease","volume":"21","author":"Guermazi","year":"2001","journal-title":"Radiographics"},{"key":"ref9","first-page":"903","article-title":"Diagnostic value of thoracoscopy for pleural effusion caused by lymphoma","volume":"41","author":"Liu","year":"2019","journal-title":"J Third Mil Med Univ"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3760\/cma.j.issn.0253-2727.2016.01.015","article-title":"Non-Hodgkin's lymphoma initially manifested with pleuraleffusion: seven case reports and literatures review","volume":"37","author":"Tan","year":"2016","journal-title":"Chin J Hematol"},{"key":"ref11","first-page":"1062","article-title":"Clinical analysis of 11 cases of lymphoma first diagnosed with pleural effusion","volume":"39","author":"Cui","year":"2019","journal-title":"Int J Respirat"},{"key":"ref12","first-page":"846","article-title":"Clinical analysis of lymphoma with chest involvement: report of 25 cases","volume":"48","author":"Zhou","year":"2009","journal-title":"Chin J Intern Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"66","DOI":"10.4103\/lungindia.lungindia_239_24","article-title":"Diagnostic value of monocyte chemoattractant protein-1 (MCP-1) and lactate dehydrogenase (LDH) in malignant pleural effusion: a cross-sectional study","volume":"42","author":"Muhammad","year":"2025","journal-title":"Lung India"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/7348239","article-title":"Differentiating malignant from tubercular pleural effusion by Cancer ratio plus (Cancer ratio: pleural lymphocyte count)","volume":"2016","author":"Verma","year":"2016","journal-title":"Can Respir J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1002\/cyto.b.21637","article-title":"The utility of multiparametric flow cytometry in the detection of primary effusion lymphoma (PEL)","volume":"96","author":"Gal\u00e1n","year":"2019","journal-title":"Cytometry B Clin Cytom"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1093\/qjmed\/hcaa140","article-title":"Peripheral T-cell lymphoma presenting with pleural effusion","volume":"114","author":"Chang","year":"2021","journal-title":"QJM"},{"key":"ref17","first-page":"607","article-title":"Diagnosis of pleural diseases without pleural effusion and with small amount of pleural effusion by medical thoracoscopy","volume":"43","author":"Wang","year":"2020","journal-title":"Chin J Tuberc Respir Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s12890-018-0619-3","article-title":"Malignant pleural mesothelioma: diagnostic value of medical thoracoscopy and long-term prognostic analysis","volume":"18","author":"Xu","year":"2018","journal-title":"BMC Pulm Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"8092","DOI":"10.3892\/ol.2017.7226","article-title":"Diagnostic value of medical thoracoscopy in malignant pleural effusion induced by non-Hodgkin's lymphoma","volume":"14","author":"Wang","year":"2017","journal-title":"Oncol Lett"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1326","DOI":"10.1016\/S0140-6736(03)13079-6","article-title":"Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial","volume":"361","author":"Maskell","year":"2003","journal-title":"Lancet"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1159\/000443483","article-title":"CT scan-guided Abrams' needle pleural biopsy versus ultrasound-assisted cutting needle pleural biopsy for diagnosis in patients with pleural effusion: a randomized, controlled trial","volume":"91","author":"Metintas","year":"2016","journal-title":"Respiration"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1378\/chest.09-0884","article-title":"Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial","volume":"137","author":"Metintas","year":"2010","journal-title":"Chest"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1002\/dc.10307","article-title":"Flow cytometry as an adjunct to cytomorphologic analysis of serous effusions","volume":"29","author":"Czader","year":"2003","journal-title":"Diagn Cytopathol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.3109\/10428194.2013.852667","article-title":"Sensitivity and specificity of cerebrospinal fluid flow cytometry for the diagnosis of leukemic meningitis in acute lymphoblastic leukemia\/lymphoma","volume":"55","author":"Mitri","year":"2014","journal-title":"Leuk Lymphoma"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1619612\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T05:20:26Z","timestamp":1765948826000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1619612\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":24,"alternative-id":["10.3389\/fmed.2025.1619612"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1619612","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]},"article-number":"1619612"}}