대한흉부영상의학회 Weekly Chest Cases

Case No : 287 Date 2003-04-26

Courtesy of Choong-Ki Park, M.D., Yong Wook Park, M.D. / Hanyang University Guri Hospital, Korea
Age/Sex 69 / M
Chief ComplaintCough

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Diagnosis With Brief Discussion

Diagnosis: Primary Pulmonary Lymphoma (Diffuse Large B-Cell Type)
Radiologic Findings: On CT scans, the left lower lobe is occupied by a bulky enhancing mass showing CT angiogram sign. There were no mediastinal and hilar lymphadenopathy. Abdominal CT showed no abnormal findings.

He was pathologically diagnosed as diffuse high-grade large B cell lymphoma. Specimen was obtained by gun biopsy from the mass in the left lower lobe. He treated lymphoma with chemotherapy.
Brief Review: Primary pulmonary lymphoma
- Designating criteria (Saltzstein): Non-Hodgkins lymphoma is limited to the lung with/without mediastinal lymph node involvement. No evidence of extrathoracic dissemination for at least 3 months after the initial diagnosis.
- Incidence: 0.34% of lymphoma, 3-4 % of all extranodal lymphoma.
- Morphologic subtypes: low-grade B-cell lymphoma (maltoma or baltoma), high grade B-cell lymphoma, angiocentric immunoproliferative lesion (lymphomatoid granulomatosis)

Low-grade B-cell lymphoma
70 - 90% of primary pulmonary lymphoma, mean ages 55-60 years, 50% asymptomatic, generally excellent prognosis, occasionally progress to high grade.
Radiologic manifestations: slowly growing solitary nodule (2-8 cm in diameter). air bronchograms in 50, focal consolidation (segmental or lobar), multiple nodules, areas of consolidation located peribronchially, pleural effusion in 10%.

High-grade lymphoma
Most commonly B-cell, occasionally anaplastic and peripheral T-cell types.
Prognosis is worse than low grade lymphoma.
Radiologic manifestations: solitary or multiple nodules. Lymph node enlargement may be present. Bilateral consolidation, diffuse reticulonodular pattern.

Angiocentric immunoproliferative lesion (lymphomatoid granulomatosis)
Prognosis depend on grade, variable.
Radiologic manifestations: multiple nodules and masses (70-80%), cavity (30-40%), areas of consolidation (50%), reticulonodular pattern (20%), pleural effusion (10-25%).
References: 1. Fraser RS, M?ler NL, Colman NL, Par?PD. Diagnosis of diseases of the chest. Sounders, 4th ed.1275-1281.
2. Ooi GC, Chim CS, Lie AK, Tsang KW. Computed tomography features of primary pulmonary non-Hodgkins lymphoma. Clin Radiol 1999 Jul;54(7):438-443
Keywords: Lung, Lymphproliferative disorder,

No. of Applicants : 24

▶ Correct Answer : 10/24, 41.7%

- Annecy Hospital, France Gilles Genin
- CIM Saint Dizier, France JC Leclerc
- CHU Nancy-Brabois, France Denis Regent
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jecheon Public Health Center, Korea Seung Hun Ryu
- National Taiwan University Hospital, Taiwan Kao-Lang Liu
- Ospedale di Jesi, Italy Giancarlo Passarini
- Seoul National University Hospital, Korea Sang Young Kim
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 9/24, 37.5%

- Asan Medical Center, Korea Eun Jin Chae
- Calmette Hospital, Lille, France Philippe Dumont
- Chung Li Ten-Chen Hospital,Taiwan Gui Lin Zheng
- Chungju Hospital Konkuk University, Korea Chang Hee Lee
- Kangbuk Samsung Hospital, Korea Semin Chong
- Maimonides Medical Center, N.Y., USA Naomi Twersky
- Nonsan Army Hospital, Nonsan, Korea Kwon Hyung Kim
- Ohio State University, Ohio, USA Sumit Seth
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 287 Date 2003-04-26

Discussion

No. of Applicants : 24