CT and PET/CT findings of primary pulmonary diffuse large B-cell lymphoma

Abstract

Rationale:Primary pulmonary diffuse large B-cell lymphoma (PPL-DLBCL) is rare and its clinical manifestations lack specificity. In this report, we present one case of PPL-DLBCL with complete clinical and imaging data, including uncontrast-enhanced CT, contrast-enhanced CT, and positron emission tomography (PET)/CT. Previous cases will also be reviewed and summarized.Patient concerns:A 62-year-old woman was hospitalized due to a swelling pain located in the right side of her back that persisted for >1 month. Local CT examination indicated a pulmonary infection and anti-infective therapy was administered; however, her symptoms did not improve. In the hospital, a lung CT scan with enhancement showed hyperintensity of the right upper lobe (RUL), ill-defined margins, inhomogeneous density, with air bronchograms, and mild-to-moderate enhancement. PET/CT showed a slight hyperintensity of mass with high uptake (about 14.7 standardized uptake value [SUV]), and no high uptake was found in other locations.Interventions:A CT-guided percutaneous needle biopsy with Tru-Cut needles was performed.Diagnoses:The final diagnosis was PPL-DLBCL.Outcomes:After 4 rounds of chemotherapy using the rituximab-cyclophosphamide hydroxydaunorubicin oncovin prednisolone (R-CHOP) regimen, the patient's pain was significantly relieved.Lessons:Finally, the PPL-DLBCL manifestation was similar to other types of PPL clinical manifestations and CT manifestations, but the PPL-DLBCL PET/CT showed an apparent, high metabolism. CT-guided percutaneous transthoracic needle biopsy can clearly diagnose the disease.

Paroxysmal supraventricular tachycardia as a major clinical presentation of the primary coronary sinus lymphoma

“…CECT can show the blood supply characteristics of the tumor. Bai et al [ 12 ] reported that CECT showed mild-to-moderate enhancement of diffuse large B-cell lymphoma, which was similar to our case. Compared with CT, echocardiography does not have the risk of radiation and contrast agent allergy.…”

Primary Pulmonary B-Cell Lymphoma: A Review and Update

“…Patients affected by PP-DLBCL present with ‘B-symptoms’, namely, fever, night sweats, and weight loss of at least 10% of body weight over 6 months [ 4 , 7 , 9 ]. Further site-specific clinical manifestations are pectoral pain, respiratory distress (in case of bronchial obstruction), dyspnea, cough, and less often hemoptysis [ 90 ].…”

“…PP-DLBCL may show a spectrum of radiologic findings, including areas of consolidation, round solid solitary or multiple nodules, a reticular/interstitial infiltrate or ground-glass appearance, with or without mediastinal lymphadenopathy [ 1 , 90 ]. Lesions are mostly bilateral, show sharp borders from the adjacent lung, and tend to be located peripherally in the lower lobe [ 10 ], thus transbronchial lung biopsy and ultrasound-guided fine needle aspiration (FNA) are reliable diagnostic methods [ 92 , 93 , 94 , 95 , 96 ].…”

Primary pulmonary lymphoma presenting as nodules and masses: a case report and literature review

“…Primary pulmonary lymphoma (PPL) is a rare disease and can present with non-specific symptoms [1]. The radiological presentation of PPL is heterogeneous, presenting as consolidation, pleural effusion, patchy infiltration, masses and nodules [2]. These characteristics can often pose diagnostic challenges to clinicians and delay the diagnosis.…”