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

Agarwal, Krishan Kant; Halanaik, Dhanapathi; Nazar, Aftab Hasan; Kumar, Rakesh

doi:10.4103/0972-3919.181529

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…[ 6 , 7 , 9 – 12 ] Some PPL-DLBCL cases can be clearly diagnosed through thoracoscopy or thoracotomy. [ 3 , 4 , 8 , 10 , 11 ] However, our case of PPL-DLBCL obtained the final pathological result through CT-guided percutaneous biopsy with Tru-Cut needles. We believe that we can obtain a relatively large tumor tissue specimen using Tru-Cut needles, and it is beneficial for obtaining a clear pathological diagnosis compared with needle aspiration.…”

Section: Discussionmentioning

confidence: 79%

“…[ 3 – 12 ] The morbidity rate in men and women is basically the same. [ 3 – 11 ] About half of PPL cases have no symptoms, or the manifestation is that patients lack specific respiratory symptoms, such as cough, dyspnea, and pectoralgia. [ 2 ] In addition to the one case of the reported PPL-DLBCL without clinical symptoms, [ 8 ] other cases have clinical symptoms from 1 week to 3 years, including systemic manifestations of fever and weakness and partial symptoms of difficulty breathing, cough, shortness of breath, chest pain, backache, and occasional weight loss.…”

Section: Discussionmentioning

confidence: 99%

“…In PET/CT, low-grade B-cell PPL is reported with even, mild FDG uptake and the maximum SUVs range from 2.3 to 5.7 SUV, with an average value of 3.3 SUV. [ 11 ] However, the PPL-DLBCL cases show marked increase in FDG uptake, [ 3 – 5 , 8 – 12 ] and the maximum range of uptake is from 6.4 to 26.1 SUV, with an average value of 15.7 SUV. [ 3 , 8 – 11 ] The high FDG metabolism observed in PPL-DLBCL cases suggests a higher grade and more invasive malignancy in comparison with low-grade PPL.…”

Section: Discussionmentioning

confidence: 99%

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

Bai

Liang

2017

Medicine

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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.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Bai

Liang

2017

Medicine

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“…As the clinical features of PPL were poorly defined, most of the patients were initially misdiagnosed as pneumonia, pulmonary tuberculosis, organizing pneumonia and lung cancer. Altough imaging manifestation of PPL had a less specificity [ 19 – 22 ], there were still some hints: 1) Fuzzy shadow at the edge of lung mass with air bronchogram; 2) Lung mass shadow stable for a long time; 3) Pneumonia-like changing without infections clinical and lab manifestation.…”

Section: Discussionmentioning

confidence: 99%

Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study

Yao

Zhang

et al. 2018

BMC Cancer

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BackgroundThe primary pulmonary lymphoma (PPL), with a low incidence, was highly misdiagnosed in clinic. The present study analyzes the clinical features, laboratory and imaging data, pathologic characteristics, and summarizes misdiagnosis reasons of PPL cases, aims to provide a better understanding and increase the accuracy of early diagnosis and minimize the misdiagnosis of PPL.MethodsThe clinical data of 19 cases were collected from the first affiliated hospital of Wenzhou medical university (PRC) from April 2010 to May 2016. All cases were confirmed by pathology. The process of misdiagnosis was described. This study retrospectively analyzed the incidence, clinical presentation, laboratory examination, Chest CT scan and diagnosis of the cases.ResultsThe symptoms of the 19 cases were dyspnea, fever, hemoptysis, chest pain or physical findings without obvious symptoms. Five patients were pneumonia-like, nine patients had lung single nodule or mass and four patients got pleural effusion, which were reported by computed tomography (HRCT) scan. There were 2 cases of Hodgkin lymphoma (HL), and 17 cases of non-Hodgkin lymphoma (NHL). In NHL cases, 12 cases were confirmed mucosa associated lymphoid tissue B lymphoma type, 3 cases were confirmed diffuse large B-cell lymphoma, angioimmunoblastic T-cell lymphoma and ALK positive anaplastic large cell lymphoma were one case separately. Clinical and imaging manifestation of PPL is untypical, but there are still some hints: 1) Fuzzy shadow at the edge of lung mass with air bronchogram; 2) Lung mass shadow stable for a long time; 3) Pneumonia-like changing without infections clinical and lab manifestation. Thirteen patients (68.4%) were misdiagnosed as pneumonia, lung cancer and tuberculosis initially. The term between initial diagnosis and final diagnosis lasted for half a month up to 2 years, with median time of 6 months. Two cases were misdiagnosed as tuberculosis. One case was misdiagnosed as small cell lung cancer.ConclusionClinical and imaging manifestation of PPL is untypical. Biopsies should be taken actively if the imaging findings don’t match the symptoms or the anti-infection treatments to “lung infection” don’t work. Accurate diagnosis requires adequate tissue sampling with appropriate ancillary pathologic studies. If clinical manifestation and the diagnosis don’t match, repeated biopsy should be ordered.

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“…1 With regard to the aggressive subset termed primary pulmonary diffuse large B cell lymphoma (PPDLBCL), we have little information about its biological characteristics, optimized therapeutic protocols, and outcomes since less than 40 cases have been reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Here, we present an instructive PPDLBCL case mimicking lung metastasis in a heavily treated breast cancer patient. In view of the patient's nonspecific discomfort, isolated subpleural nodule, and definite history of metastatic breast cancer, it could easily have been misdiagnosed as lung metastasis.…”

Section: Introductionmentioning

confidence: 99%

<p>Primary Pulmonary Diffuse Large B Cell Lymphoma Mimicking Metastasis: A Case Report and Literature Review</p>

Liu

Guo

et al. 2020

OTT

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Primary pulmonary diffuse large B cell lymphoma (PPDLBCL) is extremely rare, with fewer than 40 cases reported to date and a lack of systemic analysis. Herein, we present a case of PPDLBCL mimicking metastasis in a heavily treated patient with breast cancer. To our knowledge, this is the first reported case of PPDLBCL in a patient with breast cancer. A 66-year-old Chinese female diagnosed with breast cancer 7.5 years previously and multiple bone metastases 31 months later presented with a new-onset subpleural nodule in the inferior lobe of left lung detected by routine follow-up in November 2017. A 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography scan showed that the pulmonary nodule was hypermetabolic with a maximum standard uptake value of 14.9, consistent with lung metastasis in view of her history of breast cancer and multiple bone involvement. Surprisingly, pathologic investigation revealed primary lung DLBCL, staged IEA. Systemic chemotherapy with R-CDOP (rituximab, cyclophosphamide, vindesine, doxorubicin liposome, and prednisone) achieved complete remission with mild side effects. At the latest follow-up in August 2019, the patient had disease-free survival of 21 months. The findings from this case indicate that primary pulmonary lymphoma should be included in the differential diagnostic checklist of pulmonary occupancy, even in solid tumor patients treated with multiple modalities. When a newly developed lung nodule is identified in such patients, clinicians should not take for granted that it is lung metastasis. Pathology results are a prerequisite for making a correct diagnosis, choosing appropriate treatment, and improving patient prognosis.

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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

Cited by 6 publications

References 18 publications

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

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

Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study

<p>Primary Pulmonary Diffuse Large B Cell Lymphoma Mimicking Metastasis: A Case Report and Literature Review</p>

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