대한흉부영상의학회 Weekly Chest Cases

Case No : 561 Date 2008-07-28

Courtesy of Kyung Hee Lee, MD, Ju Won Lee, MD. / College of Medicine, Inha University, Korea.
Age/Sex 50 / F
Chief ComplaintFebrile and chilling sensation, myalgia for 10 days

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Diagnosis With Brief Discussion

Diagnosis: Non-Hodgkin's lymphoma (NK/T-cell lymphoma of nasal type)
Radiologic Findings: Chest radiographs show multiple ill-defined nodules in both lungs. HRCT scans show multiple ill-defined nodules with interlobular septal thickening in both lungs. Chest CT scans with mediastinal setting show several small lymph nodes in both paratracheal and subcarinal nodal stations, and small amount of bilateral pleural effusion.
Brief Review: This patient is diagnosed NK/T cell lymphoma by mediastinal lymph node excision and wedge resection of left upper lobe lingular segment. PET/CT and BM biopsy could not be possible because the patient expired for respiratory failure after 2 weeks.

Secondary involvement of the lung at initial presentation has been reported to occur in 12% of patients with Hodgkin's disease and 4% of NHL. The incidence of lung involvement in NHL is lower than that of Hodgkin's disease. On chest radiographs, recurrent or secondary pulmonary lymphoma may produce various patterns: bronchovascular or lymphangitic with thickening of bronchovascular bundles and interlobular septa (41%), discrete pulmonary nodular (39%), pneumonic or alveolar with areas of consolidation (14%), and miliary or hematogenous with disseminated micronodules (6%). Lymphadenopathy and pleural effusions also commonly are present. The most common CT findings are nodules or mass-like area of consolidation larger than 1cm and small nodules less than 1cm. Other manifestations include ground0lass opacities, thickening of the interlobular septa, and occasionally endobronchial lesions.

Extranodal NK/T-cell lymphoma of the nasal type has also been called angiocentric lymphoma. This disorder is more common in Asia and South America than in the United States and Europe. The nose is the most frequently involved, and other extranodal sites including the palate and upper airway are other primary involved sites. The lung is usually involved as a metastasized organ. The patients were usually elderly, with a female to male ratio of approximately 2:1. The course is aggressive, and the overall outlook is poor. The most common radiographic finding was bilateral diffuse nodular lesions. Mass-like consolidation, cryptogenic organizing pneumonia-like lesions, hilar adenopathy, and pleural effusion were also reported. These radiographic features are also associated with bronchial MALT lymphoma and cannot be used to differentiate between non-B cell malignancies of the lung.
References: 1. Lee KS. Non-Hodgkin's lymphoma. In: Muller NL, Silva IS. Imaging of the chest. Saunders, Philadelphia, 2008 pp 600-10.
2. Balikian JP, Herman PG. Non-Hodgkin's lymphoma of the lung. Radiology 1979;132:569-576.
3. Laohaburanakit P, Hardin KA.NK/T cell lymphoma of the lung: a case report and review of literature. Thorax. 2006;61:267-70.
4. Lee HJ, Im JG, Goo JM, Kim KW, Choi BI, Chang KH, Han JK, Han MH. Peripheral T-cell lymphoma: spectrum of imaging findings with clinical and pathologic features.Radiographics. 2003;23:7-26; discussion 26-8.
5. Karakus S, Yalcin S, Guler N, Coplu L, Ayhan A. Angiocentric T-cell lymphoma of the lung mimicking metastatic carcinoma. Case report. J Exp Clin Cancer Res. 1998;17:371-3.
Keywords: Lung, Mediastinum, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 67

▶ Correct Answer : 3/67, 4.5%

- Gimpo Woori Hospital , Korea (South) Son Youl Lee
- Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK

▶ Correct Answer as Differential Diagnosis : 18/67, 26.9%

- The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
- McGill University Health Centre , Canada Amr Ajlan
- China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
- E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
- Seoul National University Hospital , Korea (South) Sang Min Lee
- Asan Medical Center , Korea (South) Eun Jin Chae
- HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
- Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
- BOLLINENI HOSPITAL NELLORE , India jignesh dubal
- Seoul National University Hospital , Korea (South) Kwang Nam Jin
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Ruby Hall Clinic , India sudarshan rawat
- Dongguk University International Hospital , Korea (South) Hee Seok Choi
- Homs National Hospital , Syria Rami Abou Zalaf
- Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
- Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
- jiangsu province hospital , China yuan doctor

▶ Semi-Correct Answer : 17/67, 25.4%

- Trakya Univercity School of Medicine , Turkey Armagan Sarac
- National Taiwan University Hospital , Taiwan Chin-Chung Shu
- jaslok hospital mumbai , India jainendra jain
- MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
- Marien Hospital, Hamm , Germany Davis Chiramel
- Osaka University , Japan Osamu Honda
- National Taiwan University Hospital , Taiwan Nin Chieh Hsu
- Changhua Christian Hospital , Taiwan Chia-Fu Tsai
- Vitalife Clinics , Pune , India. , India Rahul Deshmukh
- nirman hitech diagnostic centre , India minal seth
- Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
- IRSA La Rochelle France , France Denis Chabassie
- Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
- radiology department ANNECY , France gilles GENIN
- Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- PITTWATER RADIOLOGY , Australia Julie Arora
- PITTWATER RADIOLOGY , Australia Saurabh Khandelwal

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 561 Date 2008-07-28

Discussion

No. of Applicants : 67