Clinical Analysis of 50 Cases of Primary Pulmonary Lymphoma: A Retrospective Study and Literature Review

Hu, Mingbin; Gu, Weiguo; Chen, Shaoqing; Mei, Jinhong; Wang, Weijia

doi:10.1177/15330338221075529

Cited by 5 publications

(12 citation statements)

References 32 publications

(44 reference statements)

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“…In this case, PPL was diagnosed using an invasive VATS biopsy. The treatment options include surgery or radiotherapy for localized tumours and chemotherapy for multiple/diffuse involvement 2 . In this case, as multiple lung nodules were detected, we selected chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Primary pulmonary diffuse large B‐cell lymphoma presenting multiple nodules mimicking metastasis: A case report

Fujioka

Kai²,

Kataoka³

et al. 2023

Respirology Case Reports

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Primary pulmonary diffuse large B‐cell lymphoma is a rare entity. We describe a case of pulmonary lymphoma with multiple nodules mimicking metastases in a treated patient with rheumatoid arthritis. A 73‐year‐old man was diagnosed with rheumatoid arthritis at the age of 30. He was treated with leflunomide. He was followed up for a nontuberculous mycobacterial infection. He underwent percutaneous coronary intervention for acute myocardial infarction at the age of 70. In April 2022, routine follow‐up revealed new‐onset multiple nodules on chest computed tomography (CT). A position emission tomography/CT scan with 18F‐fluorodeoxyglucose showed a low‐high maximum standardized uptake value by multiple nodules. Pathologic examination of a video‐assisted thoracic surgical biopsy revealed pulmonary diffuse large B‐cell lymphoma. Systemic chemotherapy with rituximab, cyclophosphamide, vincristine, and prednisolone reduced and eliminated multiple nodules. Pulmonary lymphoma should be considered as a differential diagnosis in the case of multiple nodules on a chest CT.

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Section: Discussionmentioning

confidence: 99%

“…Diffuse large B‐cell lymphoma (DLBCL) is accounting for >10% of PPLs 1 . Radiologically, they can present as consolidation, infiltration, masses, and nodules with nonspecific findings 2 . Here, we report our experience with a case of PPL‐DLBCL detected as multiple pulmonary nodules and masses mimicking metastasis.…”

Section: Introductionmentioning

confidence: 96%

Primary pulmonary diffuse large B‐cell lymphoma presenting multiple nodules mimicking metastasis: A case report

Fujioka

Kai²,

Kataoka³

et al. 2023

Respirology Case Reports

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“…Multislice spiral CT of the chest is the preferred method for evaluating PPL, and thin-slice CT is more valuable for displaying detailed and characteristic images of lesions ( 26 ). Tumor cells of PPL can infiltrate and diffuse along the bronchial and vascular peripheral lymphatic sinus pathways, resulting in thickening of tissue structures around bronchial, vascular and lymphatic vessels or local formation of nodules or masses ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…(D) Mixed type: mixed with 2 or more pathological types, mostly pneumonia consolidation type and nodular mass type. In low-grade NHL, mass or nodular pneumonia and solitary lobular pneumonia are more common, whereas in high-grade NHL, multilobular lesions are more common ( 26 ). In our study, we observed that pneumonia consolidation type (42.1%) and nodular/mass type (36.8%) were the most common morphological pattern.…”

Section: Discussionmentioning

confidence: 99%

Role of 18F-FDG PET/CT in patients affected by pulmonary primary lymphoma

Peng

Luo

et al. 2022

Front. Oncol.

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BackgroundPrimary pulmonary lymphoma (PPL) is defined as clonal abnormal hyperplasia of lung parenchyma or bronchial lymphoid tissue originating from bronchial mucosal tissue. However, PPL is rare, which accounts for approximately 3-4% of extraneurotic lymphomas and 0.5-1% of all primary tumors in the lung. Owing to the lack of any typical clinical symptoms and radiological features, it is challenging to accurately diagnose PPL, which affects its clinical management and prognosis. Considering this, herein, we aim to raise awareness of this disease and help physicians understand the role of 18F-FDG PET/CT in the diagnosis of PPL.MethodA retrospective analysis was performed on the clinical and 18F-FDG PET/CT imaging data of 19 patients diagnosed with PPL by biopsy pathology at our hospital from April 2014 to December 2021.ResultsOf the 19 PPL patients, 15 patients showed clinical symptoms with the most common being fever and cough. In addition, there were 4 cases that had no clinical symptoms, and all of them were MALT lymphoma. In fact, 16 patients were misdiagnosed as lobar pneumonia, lung cancer, tuberculosis, and diffuse interstitial inflammation, representing a misdiagnosis rate of 84.2%. Also, 73.7% were MALT lymphomas, representing the most common pathological pattern, along with 3 DLBCL and 2 T-cell lymphomas. With reguard to CT signs, the air-bronchial sign was found to be the most common, followed by the halo sign and the collapsed leaf sign. On the basis of the predominant radiologic features, lesions were categorized as pneumonic consolidation, nodular/mass type, diffuse interstitial type, and mixed type. The average SUVmax of lesions was 7.23 ± 4.75, the ratio of SUVmax (lesion/liver) was 3.46 ± 2.25, and the ratio of SUVmax (lesion/mediastinal blood pool) was found to be 5.25 ± 3.27. Of interest, the different pathological types of PPL showed different values of 18F-FDG uptake. The 18F-FDG uptake of DLCBL was the most prominent with a SUVmax of 15.33 ± 6.30 and was higher than that of MALT lymphoma with a SUVmax of 5.74 ± 2.65. There appeared similarity in 18F-FDG uptake between MALT lymphoma and T-cell lymphoma. For the SUVmax of lesion, we found statistical significance between MALT lymphoma and DLCBL (P value<0.001). In addition, we also found statistical significance (P value < 0.05) in SUVmax of lesions between pneumonic consolidation type and nodal/mass type, I stage, and other stages.ConclusionsOn 18F-FDG PET/CT images, certain features of PPL morphology and metabolism can be identified that may contribute to a better understanding of this disease. In addition, 18F-FDG PET/CT whole-body imaging has the potential to refine the staging of PPL. Most importantly, functional 18F-FDG PET/CT imaging can readily reflect tumor cell activity, thus allowing for the selection of an optimal biopsy site.

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“…Mucosa-associated lymphoid tissue lymphoma is the most frequent subtype, accounting for 60% to 80% of all the PPLs, followed by diffuse large B-cell lymphoma (10-25%). Others rare types of PPLs include LYG, mantle B-cell lymphoma and follicular lymphoma ( 16 ). About 36% of cases are asymptomatic at the time of diagnosis ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Simultaneous occurrence of primary pulmonary lymphoma and opportunistic infections in a patient with chronic myeloid leukemia

Bi¹,

Feng²,

Shang³

et al. 2022

Front. Oncol.

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BackgroundThe occurrence of primary pulmonary lymphoma (PPL) as a secondary malignancy in patients diagnosed with chronic myeloid leukemia (CML) is extremely rare. As the clinical manifestations are atypical, most patients with PPL tend to be misdiagnosed with pneumonia. When the radiographic features of PPL and pulmonary infection overlap, clinicians can be confused about the diagnosis. Here, we report the first case of coexistence of PPL and opportunistic infections in a patient with CML in chronic phase (CML-CP).Case presentationA 55-year-old woman presented with three weeks of hemorrhage of the oral mucosa at the Department of Hematology. After undergoing various examinations, she was diagnosed with CML-CP and was started on imatinib (400 mg/daily). Due to sudden respiratory distress, the patient was admitted to the respiratory intensive care unit 11 months later. Chest computed tomography (CT) revealed ground-glass opacities, patchy shadows, and multiple nodules in both lungs and enlarged mediastinal lymph nodes. The combination of biapenem and voriconazole antibiotic treatments was effective. The patient’s respiratory distress was relieved, but there was intermittent coughing. In the following time, the patient developed a fever, and the imaging findings indicated progression of the disease in both lungs. Bronchoalveolar lavage (BAL) identified pathogens of multiple opportunistic infections. The coexistence of lymphomatoid granulomatosis (LYG) was not confirmed in this patient until a second CT-guided biopsy was performed. Ultimately, the patient underwent chemotherapy in time and is currently alive today.ConclusionsWhen the patient’s recurrent respiratory symptoms and imaging findings do not coincide, secondary tumors should be considered in addition to infection as a diagnosis. In these cases, multiple pathological tissue biopsies should be performed.

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Clinical Analysis of 50 Cases of Primary Pulmonary Lymphoma: A Retrospective Study and Literature Review

Cited by 5 publications

References 32 publications

Primary pulmonary diffuse large B‐cell lymphoma presenting multiple nodules mimicking metastasis: A case report

Primary pulmonary diffuse large B‐cell lymphoma presenting multiple nodules mimicking metastasis: A case report

Role of 18F-FDG PET/CT in patients affected by pulmonary primary lymphoma

Case report: Simultaneous occurrence of primary pulmonary lymphoma and opportunistic infections in a patient with chronic myeloid leukemia

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