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

Abstract

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.

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

“…Although the radiographic findings were atypical, there were number of hints suggesting PP-NHL, including a fuzzy shadow at the edge of the lung mass with air bronchogram, long-term stability of the lung mass shadow and a pneumonia-like presentation without infectious clinical or lab manifestations. These radiographic findings resembled a spectrum of other pulmonary diseases, including lung cancer, metastatic tumors, pneumonia, pulmonary tuberculosis and pulmonary abscesses (20). We believe that PP-NHL should be considered in the differential diagnosis of a pulmonary lesion, in particular for patients with long-lasting pulmonary shadows, systemic symptoms, including fever, weight loss and night sweats, elevated LDH levels or poor responses to antibiotic treatments.…”

A Comparison of therapeutic strategies consisting of different combinations of surgery and/or radiotherapy in Pulmonary MALT-MZL: A population-based Analysis of SEER Data, 1992-2013

“…Pulmonary MALT lymphoma is a rare mature B-cell lymphoma that presents with an indolent clinical course and lacks of speci c manifestations in clinical ,imaging and laboratory examination, and about one-third of patients are asymptomatic at initial diagnosis [3] . Because of its low incidence rate and nonspeci c clinical features, It's often confounded with other lung diseases with higher morbidity in China, including lung cancer, pneumonia and tuberculosis, without pathologically con rmation [4] . In addition, the speci city of this anatomical site makes it di cult to obtain tumor tissues from pulmonary lesion, and it is frequent that the tissues acquired by transbronchial lung biopsy or computed tomography-guided percutaneous lung puncture are too small to make a de nite diagnosis.…”

Is percutaneous computed tomography-guided biopsy sufficient to establish indolent lymphoma transformation?

“…Using a larger needle gauge (14 or 16 G) is completely suitable for peripherally located palpable masses, conditions of the anterior and posterior mediastinum, and the abdominal cavity including retroperitoneum and pelvis. Thin needle gauges (18 G) are satisfactory for interventions affecting the pleura due to the sufficient diagnostic accuracy combined with an acceptable complication rate [25].…”