Primary pulmonary lymphoma: four different and unusual radiologic and clinical manifestations

Tanrıverdi, Elif; Acat, Murat; Özgül, Güler; Abbaslı, Kenan; Gul, Seema; Yaşar, Zehra; Çörtük, Mustafa; Fener, Neslihan; Akın, Hasan; Özgül, Mehmet Akif; Çetınkaya, Erdoğan

doi:10.1080/10428194.2016.1225210

Cited by 8 publications

(10 citation statements)

References 13 publications

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“…[ 6 , 7 , 9 – 12 ] Some PPL-DLBCL cases can be clearly diagnosed through thoracoscopy or thoracotomy. [ 3 , 4 , 8 , 10 , 11 ] However, our case of PPL-DLBCL obtained the final pathological result through CT-guided percutaneous biopsy with Tru-Cut needles. We believe that we can obtain a relatively large tumor tissue specimen using Tru-Cut needles, and it is beneficial for obtaining a clear pathological diagnosis compared with needle aspiration.…”

Section: Discussionmentioning

confidence: 78%

“…In CT scans, PPL-DLBCL has patchy or irregular consolidations with or without ground glass opacities. [ 4 , 6 , 10 – 12 ] PPL-DLBCL has single or multiple nodules [ 5 , 7 ] or huge lumps [ 9 ] and multiple thick wall cavities of occasional manifestation. [ 8 ] Interstitial involvement can also occur in PPL-DLBCL cases.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] When PPL-DLBCL infiltrates walls of the chest, the imaging may show a thickening pleural nodule with pleural effusion. [ 10 ] The enlargement of the mediastinal lymph node is occasionally merged. [ 7 ] Although PPL-DLBCL imaging lacks specificity, PPL-DLBCL needs to be considered in the condition of tumor-like consolidation with the pulmonary nodules in an air bronchogram.…”

Section: Discussionmentioning

confidence: 99%

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CT and PET/CT findings of primary pulmonary diffuse large B-cell lymphoma

Bai

Liang

2017

Medicine

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Rationale:Primary pulmonary diffuse large B-cell lymphoma (PPL-DLBCL) is rare and its clinical manifestations lack specificity. In this report, we present one case of PPL-DLBCL with complete clinical and imaging data, including uncontrast-enhanced CT, contrast-enhanced CT, and positron emission tomography (PET)/CT. Previous cases will also be reviewed and summarized.Patient concerns:A 62-year-old woman was hospitalized due to a swelling pain located in the right side of her back that persisted for >1 month. Local CT examination indicated a pulmonary infection and anti-infective therapy was administered; however, her symptoms did not improve. In the hospital, a lung CT scan with enhancement showed hyperintensity of the right upper lobe (RUL), ill-defined margins, inhomogeneous density, with air bronchograms, and mild-to-moderate enhancement. PET/CT showed a slight hyperintensity of mass with high uptake (about 14.7 standardized uptake value [SUV]), and no high uptake was found in other locations.Interventions:A CT-guided percutaneous needle biopsy with Tru-Cut needles was performed.Diagnoses:The final diagnosis was PPL-DLBCL.Outcomes:After 4 rounds of chemotherapy using the rituximab-cyclophosphamide hydroxydaunorubicin oncovin prednisolone (R-CHOP) regimen, the patient's pain was significantly relieved.Lessons:Finally, the PPL-DLBCL manifestation was similar to other types of PPL clinical manifestations and CT manifestations, but the PPL-DLBCL PET/CT showed an apparent, high metabolism. CT-guided percutaneous transthoracic needle biopsy can clearly diagnose the disease.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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CT and PET/CT findings of primary pulmonary diffuse large B-cell lymphoma

Bai

Liang

2017

Medicine

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“…Low grade B-cell PPL, as most commonly in PPL, formed almost 85–90% of all reported cases, out of which almost all cases correspond to MALT-type NHL [ 13 – 15 ]. The recent delineation of new pathologic entities such as low-grade malignant lymphoma of mucosa-associated lymphoid tissue (MALT type) had aided in the understanding of the pathophysiology, clinical course, and management of patients with pulmonary lymphoma.…”

Section: Discussionmentioning

confidence: 99%

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

Yao

Zhang

et al. 2018

BMC Cancer

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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.

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“…The vast majority of cases present as multiple nodules, consolidation, solitary masses or cavities with or without enlarged lymph nodes. A rare subtype of lymphoma can also present with diffuse ground-glass shadows or pleural effusion on a chest CT scan [13]. Therefore, the differential diagnosis includes TB, fungal infections, interstitial lung disease, neoplastic disease and metastatic spread from solid malignancies.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous occurrence of invasive pulmonary aspergillosis and diffuse large B-cell lymphoma: case report and literature review

Shao

Jiang

et al. 2020

BMC Cancer

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Background: Patients with lymphoma are at risk for developing pulmonary opportunistic infections due to immunocompromise. However, clinical reports of concurrent lymphoma and opportunistic infection at presentation are rare and often confined to single cases. A delayed diagnosis of either opportunistic infection or lymphoma usually occurs in this complex situation. Here, we report such a case and analyse 18 similar cases searched in the PubMed database to deepen clinicians' understanding. Case presentation: A 48-year-old man presented with a 3-month history of fever, cough and emaciation. Highresolution computed tomography revealed bilateral cavitating lesions of different sizes. Aspergillus fumigatus complex was identified from a bronchoalveolar lavage fluid culture. However, antifungal treatment combined with multiple rounds of antibacterial therapy was unsuccessful, and the patient's lung lesions continued to deteriorate. Multiple puncture biopsies finally confirmed the coexistence of diffuse large B-cell lymphoma. Despite the initiation of combination chemotherapy, the patient died of progressive respiratory failure. Conclusions: Synchronous pulmonary lymphoma and simultaneous opportunistic infection is rare and usually lacks specific clinical and imaging manifestations. Lymphoma should be considered as part of the differential diagnosis of patients with an opportunistic infection when treatment fails or other symptoms are present that could be considered "atypical" for the condition. Tissue biopsy is the gold standard, and multiple biopsies are essential for making the final diagnosis and should be performed upon early suspicion.

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Primary pulmonary lymphoma: four different and unusual radiologic and clinical manifestations

Cited by 8 publications

References 13 publications

CT and PET/CT findings of primary pulmonary diffuse large B-cell lymphoma

CT and PET/CT findings of primary pulmonary diffuse large B-cell lymphoma

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

Simultaneous occurrence of invasive pulmonary aspergillosis and diffuse large B-cell lymphoma: case report and literature review

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