대한흉부영상의학회 Weekly Chest Cases

Case No : 924 Date 2015-07-13

Courtesy of Taeyang Ha, Joo Sung Sun / Ajou university hospital
Age/Sex 58 / M
Chief ComplaintCough, sputum, fever for 4 months

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Diagnosis With Brief Discussion

Diagnosis: Diffuse large B cell lymphoma
Radiologic Findings: Radiologic examinations demonstrate multifocal nodules and patchy consolidations in the bilateral lungs. Several small sized lymphadenopathies in the mediastinum and hilum are noted. Splenomegaly is also identified (not shown).
CT-guided needle biopsy and additional VATS biopsy at the RML lateral segment were done. The biopsy result was confirmed as diffuse large B cell lymphoma (DLBCL).
Brief Review: Non-Hodgkin’s lymphoma (NHL) is the most common type of lymphoma and diffuse large B cell lymphoma is the most common type of NHL. In this case, we identified both pulmonary lesions and splenomegaly. Thus, secondary pulmonary lymphoma was suggested. Primary pulmonary lymphoma is limited to the lung with or without mediastinal LNs and there is no evidence of extrathoracic dissemination for at least 3 months after the initial diagnosis.

Pulmonary involvement is identified more often in HL than in NHL, and the lung is more frequently involved in disseminated or recurrent disease than in primary disease. Pulmonary parenchymal involvement may present with variable patterns. The most common feature of pulmonary involvement is the direct extension of hilar or mediastinal nodes toward the lungs; however, recurrences in the lung may be seen without associated lymphadenopathy. Other appearances include pulmonary nodules (with or without cavitation), lobar or segmental consolidation with air bronchograms representing peribronchial tumor infiltration without destruction of the bronchial wall, a reticular pattern with a bronchovascular bundle and interlobular septal thickening, disseminated small nodules, cavitating masses, endobronchial lesions, and atelectasis or obstructive pneumonia secondary to endobronchial or nodal obstruction. When these findings are seen in a patient with newly diagnosed lymphoma, pulmonary involvement of lymphoma should be considered. In treated patients, however, it is often difficult to differentiate pulmonary involvement from other benign conditions such as infection, radiation pneumonia, or drug-induced lung disease. Thus, it is important to determine whether the tumor originated from the lung parenchyma (primary pulmonary lymphoma), whether it originated in nodal tissue with direct spread to the adjacent lung, or whether it originated in nodal tissue and hematogenously spread to extranodal sites.

When we identify pulmonary consolidations and nodules, radiologists must not forget to consider lymphoma as a possible differential diagnosis
Please refer to
References: Cross-Sectional Evaluation of Thoracic Lymphoma. Radiol Clin N Am 46 (2008) 253–264
Keywords: Lung, Lymphproliferative disorder,

No. of Applicants : 70

▶ Correct Answer : 16/70, 22.9%

- Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Armed Force Seoul Hospital , Korea (South) Eui Jin Hwang
- McGill University Health Center , Canada Alexandre Semionov
- Ondokuz Mayis University , Turkey Cetin Celenk
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- Asan medical center , Korea (South) Sang Young Oh
- Niigata City General Hospital , Japan Takao Kiguchi
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- University of British Columbia , Canada Amr Ajlan
- chungbuk national university hospital , Korea (South) soojung lee
- IRSA La Rochelle , France Denis Chabassiere
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Ibaraki-gazou-shindan , Japan Shoichi Katoh
- Otsu Red Cross Hospital , Japan Hirotsugu Nakai

▶ Correct Answer as Differential Diagnosis : 40/70, 57.1%

- Juntendo University Hospital , Japan Akifumi Hagiwara
- Universidad de Chile , Chile Alvaro Zuniga
- Avrasya Hospital , Turkey Murat Ulusoy
- Kyungpook national university , Korea (South) Chungeun Lim
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
- GHICL , France manuel toledano
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- SQUH , Oman Saleh Baawain
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Okayama University Hospital , Japan Toshiyuki Komaki
- CHU Poitiers , France Yannick DE LA TORRE
- Kyoto University , Japan Akihiko Sakata
- Niigata University , Japan Atsushi Uehara
- Asan Medical Center , Korea (South) Jooae Choe
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- CHP St Martin , France mathieu namur
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Shiga University of Medical Science , Japan Akitoshi Inoue
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Asan , Korea (South) Sania ALBlushi
- Kizawa Memorial Hospital , Japan Yo Kaneko
- CHU Poitiers , France CHAN paul
- the first affiliatited hospital of nanjing medical univercity , China Hai Xu
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- Northern Yokohama Showa university , Japan Kota Watanabe
- Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
- Gifu Central Hospital , Japan Haruo Watanabe
- CLCC Rennes , France nicolas gautier
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- okayama university , Japan numa shingo
- Wuhan Union Hospital , China Qiguang Cheng
- Kizawa Memorial Hospital , Japan Shoji Okuda
- Nasaret Hospital , Korea (South) Hee Seok Choi
- University of Tsukuba Hospital , Japan Sodai Hoshiai

▶ Semi-Correct Answer : 1/70, 1.4%

- MBAL BURGAS , Bulgaria VLADISLAV RUSINOV

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 924 Date 2015-07-13

Discussion

No. of Applicants : 70