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Objective: To analyze the clinical features∗ imaging findings, diagnostic methods, pathomorphology and prognosis of the patients with primary pulmonary diffused large B-cell lymphoma (DLBCL) with the multiple ground glassy nodule shadows in the lungs as the main manifestation, and to improve the clinicians' understanding of the primary pulmonary DLBCL. Methods: The clinical data of a patient with primary pulmonary DLBCL were collected. The main manifestation in CT examination of the patient was multiple massive ground glass nodule shadows in the lungs. The initial diagnosis was pneumonia. The final diagnosis of primary pulmonary DLBCL was confirmed by pathology and immunohistochemistry examination. The related literatures were reviewed. Results: The female patient was admitted to hospital due to cough and expectoration as the first manifestations. There were no obvious positive signs in the physical examination. The CT examination results showed multiple ground glassy nodular shadows in both lungs. The tumor markers∗ lymph node color Doppler ultrasound, PET-CT∗ bone marrow biopsy∗ pathological biopsy and the other related examinations were performed∗ and the related treatment were given. The PET-CT results showed the multiple ground glass nodule in both lungs complicated with increasing of partial metabolism∗ and the pathological and immunohistochemical results suggested that the patient was non-Hodgkin DLBCL originated from the activated B cells outside the germinal center, and the final diagnosis was primary pulmonary DLBCL. The patient was given R CHOP regimen regularly. The patient received chest CT examination 3 months later, and the results showed that the massive nodule shadows in both lungs were disappeared. Conclusion: The clinical features and imaging findings of the patient with primary pulmonary DLBCL are not specific, its diagnosis ultimately relies on the pat homo pho logical and immunohistochemical examination results; the degree of malignancy of primary pulmonary DLBCL is high, and the prognosis is poor; when there are multiple ground glass nodule shadows in the lungs, the disease should be taken into account.
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Objective@#To explore the clinical characteristics, the best treatment and prognostic factors of primary pulmonary NK/T-cell lymphoma.@*Methods@#A total of 24 cases with primary pulmonary NK/T-cell lymphoma from April 2011 to May 2019 were analyzed retrospectively. Survival analysis was performed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariate analysis using Cox proportional hazard regression model was conducted to confirm independent prognostic factors for overall survival (OS) and progression-free survival (PFS) .@*Results@#①The cohort of 24 patients included 16 male and 8 female with a median age of 49 years (range, 4-76 years) old. ②Most patients initially presented with a fever (66.7%) , cough and dyspnea. Chest imaging manifestations were primarily unilateral (45.8%) or bilateral (54.2%) pulmonary consolidation, nodules or mass. ③20 patients received chemotherapy, radiotherapy or hematopoietic stem cell transplantation, the rest 4 cases palliative treatment. Median OS was 9.5 months (range, 0.1-26.0 months) . The estimated 1-year OS rate was 45.8%. Overall response rate of patients treated with asparaginase-based regimen was 88.2%. ④In univariate survival analysis, age≤60 was prognostic for longer OS and PFS, compared with age>60 (P=0.002 and 0.004, respectively) ; ECOG≤2 was prognostic for longer OS and PFS, compared with ECOG>2 (P=0.042 and 0.004, respectively) . In multivariate survival analysis, age>60 and ECOG>2 were significantly correlated with inferior OS and PFS (OS: P=0.024 and 0.024, respectively; PFS: P=0.035 and 0.024, respectively) .@*Conclusions@#Primary pulmonary NK/T-cell lymphoma was a rare disease with poor prognosis. Asparaginase-based regimens appeared to be effective. Age and ECOG served as independent prognostic factors for primary pulmonary NK/T-cell lymphoma patients.
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Objective To investigate the clinical diagnosis features of primary pulmonary lymphoma (PPL). Methods 11 cases of primary pulmonary lymphoma, confirmed by pathological examinations from January 2015 to March 2017, were studied. Most of them (10 cases) were diagnosed by endobronchial ultrasound. Results The study group consisted of 7 male (63.6％) and 4 female (36.4％) patients, aged from 35 to 72 years. 8 of 11 cases (72.7％) were more than 50 years old. The clinical symptoms consist of cough (63.6％), sputum (45.5％), breathlessness(36.4％), 2 cases were asymptomatic. The pulmonary imaging manifestation consists of four different patterns: pneumonic (72.7％);nodular or mass (45.5％); bronchovascular-lymphangitic (9.1％); milliary- hematogenous (9.1％). Air bronchograms (8 cases, 72.7％) were the common accompanying signs, typically taking the shape of withered arborization. Many cases (72.7％) were misdiagnosed, first as pneumonia or organizing pneumonia. Conclusion Primary lymphoma of the lung occurs with nonspecific clinical features, often initial misdiagnosed as pneumonia or organizing pneumonia, but it has some characteristics on radiology, such as multiple lesions, lesions accompanied with air bronchogram taking the shape of withered arborization. Final diagnosis making depended on pathological examinations by lung biopsy. The positive rate of lung biopsy by endobronchial ultrasound is also high.
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Objective To explore CT performance of primary pulmonary lymphoma(PPL)and analyze the cause of misdiagnosis. Methods CT data of 42 cases with PPL which confirmed by pathology and clinical were analyzed.All cases met the diagnostic criteria of Kim et al[1] and CT analysis of lesions included the location,shape,border,enhanced degree and internal characteristic,etc.CT images of 29 preoperative misdiagnosis cases were also analyzed and summarized.Results 34 cases underwent both pre-contrast and post-contrast scan and 8 cases only had plain CT scan.The cases included mass or nodular type(21 cases),pneumonic-alveolar type(11 cases), bronchovascular-lymphatic type(4 cases),and mixed pattern(6 cases).Meanwhile,CT features contained air-bronchus sign (32 cases),angiogram sign(20 cases),airway dilatation(4 cases)and cross lobe growing(4 cases).29 cases were misdiagnosed as other lung diseases,thus misdiagnosis rate accounted for 69%.Conclusion PPLs mainly present with intrapulmonary nodules, masses and patches.In the lesions,air-bronchus sign or angiogram sign can be seen,and the density of solid portion is homogeneous with mildly to moderately homogeneous enhancement.The coexistence of multiple-type lesions and trans-lobes distribution have certain characteristics.
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The incidence of synchronous lung tumors is rare, as reported in various clinical series, ranging from 0.2% to 8%. Most reported cases of synchronous tumors were shown to have the same histologic types of lung cancer. Among possible combinations, squamous cell carcinoma was by far the most common. Primary pulmonary lymphoma (PPL) is very rare in clinics accounting for only 0.5–1% of primary lung tumors. There is no report about synchronous primary pulmonary adenocarcinoma presenting with lung lymphoma. It can be easily misdiagnosed or missed. Although the treatment of PPL and synchronous pulmonary tumors has controversial, surgery with/without postoperative adjuvant radio‑chemotherapy are used for most patients in present. We describe a case of synchronous primary lung tumors presenting with lymphoma and adenocarcinoma, in which expression of the cell surface antigens were evaluated immunohistochemically. By taking into consideration of the reported experiences, the author discusses the clinical features, prognostic criteria and therapeutic management of synchronous lung cancer and PPL.
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Primary Pulmonary Lymphomas (LPP) are infrequent and their clinical manifestations and images are usually non specific. Diagnostic delay may be important. The objective of this study was to analyze the LLP in our institution. Between 2003 and 2013, over 1,892 lymphomas were analyzed in our institution. Only 4 of them (0.21 percent incidence) were detected as LPP: Non Hodgkin's Lymphoma (n = 2), Hodgkin's Lymphoma (n = 1), and Intravascular Pulmonary Lymphoma (n = 1). Clinical manifestations of the 4 cases presented were unspecific: 1) pulmonary mass and pleural effusion; 2) consolidation with air bronchogram and cavitations; 3) normal images and 4) pulmonary mass. Given these clinical settings, 4 diagnostic methods were used: 1) Computed Tomography-Guided Puncture, 2) Video-Assisted Thoracoscopic Surgery (VATS); 3) VATS guided by positron emission tomography (PET) and 4) thoracotomy. Hence, diagnosis was successfully made between 45 to 90 days from the initial consultation. This report confirms the low incidence of LPP, and its unspecific clinical and radiographic manifestations that may cause delay in diagnosis. PET can contribute to improve diagnostic performance, especially in patients without apparent lung involvement.
Los linfomas primarios de pulmón (LPP) son infrecuentes. Sus manifestaciones clínicas y las imágenes son inespecíficas. El retraso diagnóstico puede ser considerable. Objetivo: Analizar los LPP durante el período 2003-2013 en nuestra institución. Sobre 1892 linfomas, 4 fueron LPP (0,21 por ciento): 1) linfoma no Hodgkin (n = 2); 2) linfoma Hodgkin (n= 1); 3) linfoma intravascular pulmonar (n = 1). Las manifestaciones clínicas y radiológicas fueron inespecíficas (masa pulmonar y derrame pleural, consolidación con broncograma aéreo y cavitación o bien ausencia de lesiones). Los métodos diagnósticos fueron: 1) punción guiada bajo TAC; 2) videotoracoscopía (VATS) y 3) VATS orientada por PET (tomografia por emisión de positrones) y 4) toracotomía. El tiempo entre la consulta inicial hasta el diagnóstico fue de 45 a 90 días. Este reporte confirma la baja incidencia de LPP, y sus manifestaciones clínicas y radiologías poco específicas. Esto puede contribuir a las demoras en el diagnóstico. El PET puede mejorar el rendimiento diagnóstico, en especial en ausencia de compromiso pulmonar radiológico evidente.
Subject(s)
Humans , Male , Adult , Female , Aged , Lymphoma/diagnosis , Lung Neoplasms/diagnosis , Hodgkin Disease/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma/therapy , Lung Neoplasms/therapy , Positron-Emission Tomography , Tomography, X-Ray ComputedABSTRACT
The primary pulmonary lymphomas are uncommon, accounting for 0.5% of primary lung tumor and 0.4% of all malignant lymphomas. The majority of primary pulmonary lymphomas are of B-cell originating from bronchus associated lymphoid tissue(BALT). Angiocentric lymphoma is a rare type of primary pulmonary lymphomas characterized by polymorphic lymphoid infiltrates, which make it even more difficult to differentiate from benign infiltration. The radiographic findings are variable, depending on the stage of evolution of the disease. The prognosis of angiocentric lymphoma is poor, nearly two-thirds of the patients with grade 2 or 3 angiocentic lymphomas were died within a year of diagnosis. We report a case of primary pulmonary angiocentric lymphoma manifested as a mass of right lower lobe.
Subject(s)
Humans , B-Lymphocytes , Bronchi , Diagnosis , Lung , Lymphoma , PrognosisABSTRACT
Primary pulmonary lymphoma (PPL) is an uncommon tumor, which constitutes 3-4% of all exuanodal lymphomas and 0.3-0.5% of all primary pulmonary malignant tumors. Low-grade B-cell lymphomas of bronchus-associated lymphoid tissue (BALT) accounted for the majority of PPL. This BALT lymphomas are frequently asymptomatic and have an excellent prognosis and an indolent clinical course by contrast with T-cell type. Therefore, determination of the B- or T-immunophenotype of the tumor cells is known 13 be very important from a clinical aspect Recent advances in immunohistochemical techniques, cytogenetics, and molecular biology have allowed better definition of type, maturation and clonality of lymphoma cells and have made it possible to better understand the PPL. We experienced an asymptomatic 43-year-old man who was evaluated for infiltrates on both sides discovered incidentally after a routine chest roentgenogram. He was eventually diagnosed as low-grade B-cell lymphoma of BALT by immunohistochemical staining from specimens obtained by open lung biopsy. He was treated with combination chemotherapy. At follow up 12 months following initial diagnosis he remains in stable. We report this case, who showed a relatively favorable prognosis and indolent clinical course compatible with low-grade B-cell lymphoma.