Primary Pulmonary Diffuse Large B-Cell Lymphoma on FDG PET/CT-MRI and DWI

Abstract

Primary pulmonary diffuse large B-cell lymphoma (PPDLBCL) directly arising from lung tissue is extremely rare. It may usually be misdiagnosed as inflammation including pulmonary tuberculosis, even lung cancer, because its clinical symptoms and signs are often nonspecific. The final diagnosis usually depends on lung biopsy. Herein, we report a case of PPDLBCL and review of diagnosis of this disease, particularly in radiology.A 44-year-old man presented with cough, sputum, and intermittent chest pain for 4 weeks. Multiple radiological examinations showed an irregular mass in the right upper lobe with ground-glass opacities around it and air-filled bronchi in the consolidation. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography-magnetic resonance imaging (MRI) detected positive FDG uptake, and diffusion-weighted imaging indicated abnormal hyperintension in the lesion. Inflammation was suspected, but malignance cannot be excluded.Finally, ultrasound-guided fine-needle aspiration cytology was performed for histological examination and definitive diagnosis yielded lymphomatous cells infiltration in the right upper lobe.This report emphasizes the significance of multimodality radiological examinations. Multimodality imaging contributes to proper diagnosis, staging, and management of lymphomas.

Primary pulmonary lymphoma-role of fluoro-deoxy-glucose positron emission tomography-computed tomography in the initial staging and evaluating response to treatment - case reports and review of literature

“…Most of them represent isolated case reports and two articles concentrates on a small group of patients [ Table 1 ]. [ 14 15 16 17 18 19 20 ] PPL can be rarely presented as multiple cavitating pulmonary nodules; however, cavitation has been reported more frequently in the setting of HIV infection. In a report by Madan et al ., author showed intense FDG uptake in bilateral cavitary pulmonary nodules which histopathologically diagnosed as primary pulmonary diffuse large B-cell lymphoma.…”

Image-guided radiation therapy in lymphoma management

“…However, both modalities rely largely on size criteria to define disease and large treated nodal masses or diffuse visceral involvement frequently can be difficult to interpret by either CT or MRI. Perhaps diffusion-weighted MRI, which can detect small areas of restricted diffusion of water in tumors and appear as bright spots on MRI imaging, has been increasingly used in the tumor evaluation and treatment response assessment for various cancers and may complement the current functional imaging for predicting local treatment response in lymphoma [ 18 19 20 21 ].…”

Significance of imaging and clinical features in the differentiation between primary and secondary pulmonary lymphoma

“…Establishing radiological criteria for discrimination between these two types of lymphoma may be beneficial in guiding early diagnosis, evaluation and initiation of therapy (13,23). This is important as therapeutic strategy and prognosis differ significantly between the two (19).…”

“…Additionally, PPL, considering MALT as the most common type, exhibits with a better outcome compared with SPL (11). Chest, abdominal and pelvic enhanced-computed tomography (CT) are referred to as a basic diagnostic investigation of pulmonary lymphomas in the National Comprehensive Cancer Network (NCCN) guideline of 2015, while positron emission tomography (PET)-CT is recommended for in depth evaluation (12,13). PET/CT possesses increased accuracy in the overall staging of lymphoma compared with CT, and is often used alongside CT scans in the evaluation of patients with lymphoma (13).…”

“…Chest, abdominal and pelvic enhanced-computed tomography (CT) are referred to as a basic diagnostic investigation of pulmonary lymphomas in the National Comprehensive Cancer Network (NCCN) guideline of 2015, while positron emission tomography (PET)-CT is recommended for in depth evaluation (12,13). PET/CT possesses increased accuracy in the overall staging of lymphoma compared with CT, and is often used alongside CT scans in the evaluation of patients with lymphoma (13). The World Health Organization published a classification scheme in 2008 that grouped lymphomas by cell type, as well as by molecular, cytogenetic and phenotypic characteristics (14).…”