Diffuse large B‐cell lymphoma presenting as large anterior chest wall mass involving pleura and lung: A possible result of post‐traumatic chronic inflammation

Abstract

A 67 year-old-man was hospitalized due to chronic pain and a large mass on the anterior chest wall. His medical history showed chest trauma in 1970, the reconstitution of the scenario revealed there was blunt trauma with swelling and rib fracture on the same side. Physical examination revealed an isolated large anterior chest wall mass. Chest radiography showed two bilateral irregular masses, chest computed tomography showed a large right chest wall tumor with pleural effusion, nodules of the right upper lobe and tumor of the left lower lobe without mediastinal lymphadenopathy. Whole body exploration showed only the chest disease. Transthoracic biopsy showed inflammatory reaction. Surgical biopsy by anterior thoracotomy of the right mass was performed under general anesthesia. Histological and immunohistological analysis revealed lymphoid diffuse large cell proliferation with positive staining of CD 20, BCL-6 and MUM1, confirming the diagnosis of diffuse large B-cell malignant lymphoma. Chemotherapy based on CHOP-21 (cyclophosphamide, doxorubicin, vincristine, and prednisolone) was administered with good response after three cycles. The patient was discharged under surveillance in good condition after the end of chemotherapy. We report an infrequent neoplasm with an unusual and subtle clinical presentation. Case reportA 67 year-old-man was admitted to our department for a painful large right anterior chest wall mass who had for 2 months in the context of weight loss of 5 kg. His medical history showed chest trauma and tobacco smoking (30 package/year) weaned 10 years prior to presentation. Questioning about the chest trauma which had occurred in 1970 found that the patient has suffered a fall from height of 2 m onto a metal object causing acute pain and swelling of the chest wall. This swelling had been neglected with the patient self medicating with analgesic treatment. No interventions were made at the time. The swelling was renitent with moderate chronic chest pain certainly related to a rib fracture associated with hematoma of the chest wall. Clinical examination at admission revealed a 12x7 cm hard mass poorly defined and localized to the right anterior chest wall without inflammatory signs. The patient was in fairly good general condition and apyretic. The lymph nodes, subclavicular and cervical region were without anomaly, as were abdominal and pelvic examinations. Chest radiograph (Fig. 1) showed two abnormal irregular opacities localized to the right parahilar and in the left lower lobe. Chest computed tomography (CT) showed two abnormal masses with irregular contours, the first mass was larger and confined to the right chest wall with bone destruction and the old rib fracture (arrow in Fig. 2),

Chest wall lymphomas: Fine needle aspiration cytodiagnosis and review of the literature

“…DLBCL is a group of large, lymphoid B‐cell malignant proliferations that is clinically, morphologically and genetically heterogeneous, constitutes 30% of all NHL and the most common histological subtype; microscopically the cells of DLBCL are large with vesicular nuclei, and prominent nucleoli and immunocytochemically the cells are LCA+, CD20+, CD3‐, BCL2+ and BCL6+ . Chest wall DLBCL/TCRBCL as per our review of literature accounted for 11 of 20 (55.0%) of cases . We did not diagnose any DLBCL as such by FNA cytology in our material, but our cytologically diagnosed centroblastic lymphoma cases (two of 10 NHL) proved to be DLBCL histologically.…”

“…Review of literature corresponding to our 15‐year study period (2000‐2015) revealed 20 reports based either on cases series or isolated cases (Table ) in which 26 histologically confirmed chest wall lymphoma cases were described . Location of the swellings was the anterior chest wall/manubrium in 14 cases, left chest wall (four cases), right chest wall (three cases), lateral chest wall (NOS in two cases), back in one case and rib/chest wall swellings and NOS in two cases.…”

“…During the past one and half decades, only two case series of chest wall lymphomas were found in the published literature . On rare occasions fine needle aspiration (FNA) cytology has been utilised as a diagnostic tool for chest wall lymphomas with limited success . Our experience with 11 chest wall lymphoid neoplasms diagnosed during the past 15 years by FNA cytology and review of published literature on this subject is described.…”

Primary diffuse large B-cell lymphoma of the chest wall: a case report

“…This could then lead to lymphomagenesis, as seen in PAL. Fouad et al [19] reported the case of another patient with DLBCL that developed in the chest wall. The patient had a history of blunt trauma with swelling and rib fracture, 41 years prior.…”

Primary Pulmonary Lymphoma and Cutaneous Metastasis: A Case Report

“…The most common presentation of PPL is minor non-specific symptoms, such as persistent cough, or maybe asymptomatic in up to one half of the cases ( 7 ). Radiographic findings of PPL are not specific, but the typical presentations are single or multiple nodular shadows that may involve one or both lungs, these well-defined infiltrations frequently have air-bronchograms ( 5 , 8 , 9 ), and the nodal involvement in about 30% of the cases is detectable ( 9 ). Less than 10% of the patients have bilateral diffuse ill-defined infiltrations along the bronchovascular pattern and interlobular septa, which have reticulonodular opacities, and atelectasis or pleural effusion are rarely seen ( 10 , 11 ).…”