Precursor T-Lymphoblastic Lymphoma Presenting With a Cough: A Case Report

Lymphoblastic lymphoma (LBL) is a rare subtype of non-Hodgkin lymphoma (NHL) and the majority (85-90%) of the cases are comprised of precursor T-lymphoblastic lymphoma (T-LBL). We report a case of a 17-year-old male who presented with a productive cough for one month along with complaints of difficulty in breathing (unrelated to exertion) for four days and chest pain (left-sided, non-radiating) for two days. On clinical examination, lymphadenopathy was observed; mid jugular cervical lymph nodes were palpable on the left side, which were non-tender, matted, and approximately 1 x 1 cm in diameter. CT pulmonary angiogram showed a diffuse isodense mass in the mediastinum involving perivascular, pretracheal, paratracheal, and subcranial spaces. CT findings suggested multiple lymph nodal masses, possibly lymphoma. On histopathology, it was initially reported as NHL and, on immunohistochemistry, it was confirmed as T-LBL. A thorough clinical examination of the patient along with appropriate investigations is required to reach a precise diagnosis and achieve favorable outcomes. This case is unique as the patient presented with a cough and was reported to have NHL on histopathology.