Primary mucosa-associated lymphoid tissue lymphoma as a pleural mass

Abstract

ABSTRACT. Primary pleural lymphoma is a rare entity that has been described in association with human immunodeficiency virus (HIV) infection or pyothorax. It occurs in only 7% of primary lymphoma cases. We report the case of a 52-year-old male with no history of HIV infection or pyothorax who was diagnosed of obstructive sleep apnoea syndrome (OSAS) and underwent a routine chest X-ray to screen for any organic cause of the symptoms. The radiograph revealed two voluminous masses with extraparenchymatous features but without pleural effusion. A contrast-enhanced CT was performed and confirmed the existence of the pleural masses that showed homogeneous attenuation. Neither mediastinal lymphadenopathy nor pleural effusion were present. A percutaneous CT-guided fine needle aspiration cytology (FNAC) with a 25-G needle was performed (two samples were obtained) and the first diagnosis was of non-Hodgkin's lymphoma. The final diagnosis of primary pleural mucosa-associated lymphoid tissue (MALT) lymphoma was confirmed by a CT-guided core biopsy with a 20-G needle. To the best of our knowledge, no cases of MALT lymphoma presenting as pleural masses without pleural effusion have been reported in immunocompetent patients. In this report, we describe the case of a patient with a primary pleural MALT lymphoma and include a short review of the literature.

Diagnostic value of medical thoracoscopy in malignant pleural effusion induced by non‑Hodgkin's lymphoma

“…CT findings in pleural NHL are similar to those in pleural metastasis or malignant mesothelioma (23)(24)(25). The present study revealed that, in addition to pleural effusion, NHL mainly appears as diffuse pleural thickening and localized nodules or masses on CT scans.…”

The Pleural Sandwich Sign in Two Cases of Primary Pleural Lymphoma

“…Occasionally it appears as isolated pleural effusion prior to the development of a demonstrable mass. CT findings of primary pleural lymphoma are similar to those of pleural metastasis or malignant mesothelioma ( 6 , 7 ). For lymphoma occurring in the thorax, Kunimasa et al ( 8 ) described the "thoracic sandwich sign" as an anterior mediastinal mass encasing the superior vena cava and brachiocephalic vein that is unlikely to be caused by other mediastinal malignancies (such as lung cancer, metastatic cancer, germ-cell cancer, and thymoma) because they often quickly invade large mediastinal vessels.…”

“…Primary pleural lymphoma, accounting for only 7% of primary lymphoma cases ( 3 ), usually affects patients with HIV infection or chronic pyothorax ( 4 ). Primary pleural lymphoma occurring in immunocompetent patients without history of chronic tuberculous empyema is extremely rare ( 5 , 6 ).…”

“…Therefore, minimally invasive surgical biopsy via thoracoscopy or video-assisted thoracoscopy is recommended for early diagnosis ( 5 ). However, in cases with large pleural masses, enough specimens for the diagnosis of lymphoma can be obtained by multiple biopsies using a cutting needle ( 6 ). In the present two cases, we performed ultrasonography-guided percutaneous needle biopsy using 18-gauge automated cutting needle since the pleural masses were large.…”

Rare case of primary extranodal marginal zone lymphoma of the thorax

“…Primary pleural lymphoma occurring in immunocompetent patients without history of chronic tuberculosis, empyema or HIV infection is extremely rare [[2], [3], [4]]. It accounts for about 0.3–1% of extranodal lymphoma [1].…”