Primary pulmonary lymphoma mimicking a refractory lung abscess: A case report

Matsumoto, Takeshi; Otsuka, Kojiro; Funayama, Yuki; Imai, Yukihiro; Tomii, Keisuke

doi:10.3892/ol.2015.2929

Cited by 11 publications

(16 citation statements)

References 16 publications

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“…However, this phenomenon is also seen with osteomyelitis, assorted metal implants and chronic venous ulcer and almost all cases are EBV-positive (Mori et al 1996;Copie-Bergman et al 1997;Cheuk et al 2005). In contrast, there are a few reports on EBV-negative DLBCL arising from the replacement of a prosthesis or refractory lung abscess (Matsumoto et al 2015;Sunitsch et al 2016). Likewise, our case was EBV-negative DLBCL.…”

Section: Discussioncontrasting

confidence: 68%

Diffuse Large B-Cell Lymphoma Arising from the Lesion of Chronic Lobar Atelectasis

Fujita

Ando

Goto

et al. 2020

Tohoku J. Exp. Med.

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Pulmonary lymphoma is rare, accounting for < 1% of primary lung cancers. Most primary pulmonary lymphomas (PPL) are low-grade mucosa-associated lymphoid tissue (MALT)-type, and among PPL, diffuse large B-cell lymphoma (DLBCL) is extremely rare. In contrast, there has been an increase in the incidence of DLBCL among patients with autoimmune disorders and recurrent or chronic bacterial infection. A subset of DLBCL has been reported to develop through transformation of preexisting or concurrent MALT. The respiratory symptoms are non-specific, and the chest X-ray findings demonstrate the presence of interstitial and mixed alveolar infiltrates, nodular lesions, and localized homogeneous consolidations; the diagnosis of pulmonary DLBCL is thus challenging and often leads to a misdiagnosis or delayed diagnosis. We herein report a case of DLBCL which was assumed to have arisen from the lesion of chronic atelectasis that was successfully diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). A 74-year-old woman with diffuse bronchiectasis and chronic atelectasis of the left lower lobe suffered from productive cough and high fever. Increased airway filling with mucoid secretion was repeatedly observed within the area of atelectasis with bronchiectasis, and left lower lobe atelectasis developed. Subsequently, the hilar and mediastinal lymph nodes gradually became enlarged, and DLBCL was pathologically confirmed. In the present case, DLBCL was considered to have arisen in the lesion of chronic atelectasis. Physicians should recognize that DLBCL may develop at the site of chronic atelectasis during disease course of diffuse bronchiectasis, and thus DLBCL may be misdiagnosed as superimposed infection of chronic atelectasis.

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Section: Discussioncontrasting

confidence: 68%

Diffuse Large B-Cell Lymphoma Arising from the Lesion of Chronic Lobar Atelectasis

Fujita

Ando

Goto

et al. 2020

Tohoku J. Exp. Med.

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“…If positive specimens cannot be obtained, VATS should be selected, since it is safer and less invasive compared with conventional surgery. Clonal analysis of alveolar lymphocytes using bronchoalveolar lavage fluid (BALF) has been recently suggested to be helpful in diagnosing PP-NHL (21,22), although BALF alone may not be sufficient for morphological analysis (23). PET-CT may be helpful for initial staging and evaluation of the response to chemotherapy (24).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical observations of early-stage or indolent lymphomas are also advisable (26); therefore, a total of 7 patients diagnosed with primary pulmonary MALT lymphoma were under watchful waiting and clinical observation only in the present study. Regarding aggressive lymphomas, including DLBCL, combination chemotherapy regimens are often administered following attempts at curative surgical resection (23). CHOP or rituximab-CHOP combined with radiotherapy has previously been recommended for patients with aggressive lymphomas, radiotherapy was used to treat those patients who exhibited chemotherapeutic resistance, and dose-adjusted EPOCH was recommended as an alternative regimen (28).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and prognostic factors for patients with primary pulmonary non‑Hodgkin's lymphoma: A 16‑year single‑center retrospective study

et al. 2019

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Primary pulmonary non-Hodgkin's lymphoma (PP-NHL) is a rare entity with non-specific symptoms and radiographic findings, as well as a difficult preoperative diagnosis. A limited number of studies have described PP-NHL in Chinese patients. The goal of the present study was to improve early diagnosis by examining prognostic factors in patients with PP-NHL. Therefore, a total of 29 patients with PP-NHL were included in the study between January 2001 and June 2017, including 14 with aggressive-type and 15 with indolent-type lymphomas (10 male, 19 female; median age, 50.3 years; range, 19-87 years). Pulmonary nodules and masses (55.2%) were the most common radiographic features. The diagnostic yield was 80% (12/15) by endobronchial biopsy or transbronchial lung biopsy and 100% by computed tomography (CT)-guided percutaneous needle lung biopsy (11/11) or surgery (8/8). Elevated lactate dehydrogenase levels and systemic symptoms were observed considerably more often in patients with aggressive disease than in those with indolent disease. The 1-, 3-and 5-year overall survival (OS) rates were 42, 32, and 21%, respectively, for all patients, 72, 57 and 43%, respectively, for patients with indolent lymphomas, and 13, 6 and 0%, respectively, for patients with aggressive lymphomas. The median OS rate for all patients was 12.0 months; however, the OS rate for patients with aggressive lymphomas was significantly shorter compared with those with indolent lymphomas (7.1 months vs. 16.6 months; P=0.002). Aggressive vs. indolent lymphoma status was indicated to be an independent prognostic factor for poor 5-year OS rate (hazard ratio, 5.98; P=0.014). In conclusion, bronchoscopic and CT-guided percutaneous needle lung biopsies were the most useful and least invasive procedures for diagnosing PP-NHL. Furthermore, aggressive PP-NHL was highly associated with poor 5-year OS rate and a poor prognosis.

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“…Cavitation is common regardless of immune status, particularly in larger lesions (17,25). Clinical and imaging features may mimic those of necrotic pneumonia ( Fig 5) (29). Associated mediastinal adenopathy and pleural effusion are more common in DLBCL than in lower-grade forms of PPL (25,27).…”

Section: Lung Clinical Features and Ct Findingsmentioning

confidence: 99%

Spectrum of CT Findings in Thoracic Extranodal Non-Hodgkin Lymphoma

et al. 2017

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Non-Hodgkin lymphoma (NHL) frequently manifests in extranodal structures in the chest, often in the form of secondary involvement but occasionally as primary disease. Because staging and treatment are affected by the presence of extranodal disease at imaging, radiologists' interpretation and management of suspicious findings are critical to patient care. Unfortunately, owing to considerable imaging overlap with other diseases, primary extranodal lymphoma is difficult to diagnose with imaging alone. Radiologists should have a heightened degree of suspicion in patients at risk (including patients with immune compromise, autoimmune diseases, or a history of stem cell or solid organ transplant) or with particular imaging appearances (including the vertebral wraparound sign, nonresolving consolidation, an infiltrative soft-tissue mass, and lesions demonstrating vascular encasement without invasion). For patients with known NHL, positron emission tomography/computed tomography (PET/CT) using fluorine 18 (F)-labeled fluorodeoxyglucose (FDG) is now preferred for routine staging in most cases. CT remains heavily used, and identification of subtle extranodal involvement with CT can be improved with use of intravenous contrast material and careful review of multiplanar images. Pericardial effusion, pleural soft tissue (even when mild), mass-like consolidation, perilymphatic nodularity, and new lytic bone lesions are particularly suggestive of secondary involvement in a patient with known NHL. Magnetic resonance imaging is a helpful problem-solving tool when equivocal findings would change staging and treatment. This comprehensive review illustrates the spectrum of CT manifestations of extranodal NHL in the chest, including the pleura, lung, airways, heart, pericardium, esophagus, chest wall, and breast. RSNA, 2017.

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Primary pulmonary lymphoma mimicking a refractory lung abscess: A case report

Cited by 11 publications

References 16 publications

Diffuse Large B-Cell Lymphoma Arising from the Lesion of Chronic Lobar Atelectasis

Diffuse Large B-Cell Lymphoma Arising from the Lesion of Chronic Lobar Atelectasis

Diagnostic and prognostic factors for patients with primary pulmonary non‑Hodgkin's lymphoma: A 16‑year single‑center retrospective study

Spectrum of CT Findings in Thoracic Extranodal Non-Hodgkin Lymphoma

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