Diagnosis and management of a patient with primary pulmonary diffuse large B-cell lymphoma: A case report and review of the literature

Abstract

Primary pulmonary lymphoma (PPL) is an uncommon type of non-Hodgkin’s lymphoma. The majority of PPLs are of low-grade, mucosa-associated lymphoid tissue type. Primary pulmonary diffuse large B-cell lymphoma (DLBCL) is extremely rare, and prompt diagnosis may be challenging since its clinical symptoms and signs are nonspecific. Although the clinical features, diagnostic procedures, optimal management and prognostic factors of this disease have not yet been well defined, open thoracotomy and chest computed tomography (CT)-guided percutaneous biopsy are the preferred methods used in previous studies. In the present case report, the diagnosis and management of a patient with primary pulmonary DLBCL is reported. A 68-year-old patient was admitted to hospital in May 2013, with complaints of shortness of breath and intermittent wheezing and a cough associated with the production of small amounts of phlegm. Following admission, chest CT scans revealed a mass in the right middle lobe with ground-glass opacities at the lesion margins, as well as air bronchograms in the areas of consolidation. Bronchoscopy was performed and revealed an endobronchial lesion and partial stenosis in the distal end of the middle segment bronchus. Transbronchial needle aspiration (TBNA) of the right hilar lymph node, as well as endobronchial biopsy, was performed. The patient was diagnosed with primary pulmonary DLBCL by subsequent histopathological and immunohistochemical analysis of biopsy specimens collected via TBNA. Following the final diagnosis, standard treatment with CHOP chemotherapy resulted in significant clinical and radiological response and the patient remained in remission 8 months later. These results indicate that TBNA may be an effective method for the diagnosis of primary pulmonary DLBCL.

Diagnostic and prognostic factors for patients with primary pulmonary non‑Hodgkin's lymphoma: A 16‑year single‑center retrospective 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). Although chemotherapy or radiotherapy should be considered for unfavorable primary pulmonary non-MALT lymphomas (2), in the present study, the objective response rate (7.1%) to the treatment of primary pulmonary aggressive lymphomas was inadequate.…”

Fever and arthralgia as the initial symptoms of primary bone marrow diffuse large B-cell lymphoma: A case report

“…The diagnosis of primary bone marrow DLBCL is difficult due to the absence of guidelines regarding clinical features, optimal management, diagnostic procedures and prognostic factors (8). As no lesions were observed in the present case, and only fever and joint pain were reported, multiple bone marrow biopsies in different locations were performed.…”

“…The rapid diagnosis of primary bone marrow DLBCL is challenging, as the clinical symptoms and signs are nonspecific. In addition, the clinical features, optimal management, diagnostic procedures and prognostic factors associated with this disease remain to be elucidated (8). Recently, the diagnostic criteria for primary bone marrow lymphoma (PBML) have been proposed, and the clinicopathological features of this extremely rare tumor have also been documented (7).…”

Follicular B-Cell Lymphoma Embedded in a Pulmonary Chondroid Hamartoma: A Case Report

“…Although the diagnostic procedure of this disease has not been well defi ned, open thoracotomy or chest CT-guided percutaneous biopsy are the preferred methods used [8].…”

“…By contrast, the diagnostic value of chest CT-guided percutaneous biopsy has a low medical cost and less serious complications. However, the procedure is limited for the diagnosis of masses that are in or adjacent to the hilum or mediastinum [8].…”