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Weekly Chest CasesArchive of Old Cases

Case No : 860 Date 2014-04-21

  • Courtesy of Sung Ho Hwang, Soo-Youn Ham, Yu-Whan Oh / Korea University Anam Hospital
  • Age/Sex 48 / M
  • Chief ComplaintIncidental abnormal finding on chest radiography
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Primary pulmonary lymphoma (Extranodal marginal zone B cell lymphoma)
Radiologic Findings
Chest PA shows consolidation persisted despite antibiotic therapy. Contrast-enhanced chest CT confirms right middle lobe consolidation without remarkable enhancement. However, there was no remarkable mediastinal and cervical lymph node enlargement. Sequentially, this patient underwent PET/CT and CT guided gun needle biopsy to rule out the malignancy. PET/CT image shows increased FDG uptake only at the right middle lobe consolidation.
Brief Review
Primary pulmonary lymphoma can be defined as lymphoma that is initially localized in lung tissue. At the diagnosis, patients` age ranges from 50 to 60 years old. Most of primary pulmonary lymphoma is low-grade B-cell tumors. Grossly, low-grade B-cell lymphoma appears as a well-circumscribed nodule or a focal area of parenchymal consolidation. Underlying lung structures as airways and vessels are often recognizable. The second most common primary tumor as lymphomatoid granulomatosis is high-grade and may have either a B- or T-cell phenotype, and be commonly associated with necrosis. Typical CT findings of primary pulmonary lymphoma include solitary or multifocal nodules or masses and areas of airspace consolidations with an air bronchogram. Because the bronchi and membranous bronchioles tend to be unaffected, an air bronchogram can be commonly noted. Less common CT findings includes interlobular septal thickening, centrilobular nodules, and bronchial wall thickening. In the treatment, surgical resection can be recommended for localized diseases. And, 5-year survival rate is greater than 80%.
References
1. Addis BJ, Hyjek E, Isaacson PG. Primary pulmonary lymphoma: A re-appraisal of its histogenesis and its relationship to pseudolymphoma and lymphoid interstitial pneumonia. Histopathology. 1988;13:1-17
2. Bae YA, Lee KS, Han J, Ko YH, Kim BT, Chung MJ, Kim TS. Marginal zone b-cell lymphoma of bronchus-associated lymphoid tissue: Imaging findings in 21 patients. Chest. 2008;133:433-440
3. Ooi GC, Chim CS, Lie AK, Tsang KW. Computed tomography features of primary pulmonary non-hodgkin's lymphoma. Clinical radiology. 1999;54:438-443
Keywords
Lung, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 75

▶ Correct Answer : 25/75,  33.3%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - University of British Columbia , Canada Amr Ajlan
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - aa , Korea (South) Hyun suk Cho
  • - Kyoto University , Japan Akihiko Sakata
  • - National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - chp st martin , France Mariotte benoit
  • - the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Chungbuk univertisy hospital , Korea (South) Soohyun Lee
  • - 異⑸ , Korea (South) Yunhee Jang
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Chonnam National University Hospital , Korea (South) Sungmin Moon
  • - 異⑸ , Korea (South) Junghwan Kim
  • - SNUH , Korea (South) Eui Jin Hwang
  • - Chungbuk national university , Korea (South) Yong Kim
▶ Correct Answer as Differential Diagnosis : 26/75,  34.7%
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Montreal , Canada Drago Le King
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan medical center , Korea (South) Sang Young Oh
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Goa Medical College , India Paresh Desai
  • - HNHXZL Hospital , China DUO GE
  • - Kanto Rosai Hospital , Japan tomoko sako
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Japanese national center hospital of neurology and psychiatry , Japan Kaoru Sumida
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - CLCC Rennes , France nicolas gautier
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Onomichi municipal hospital , Japan Toshiyuki Komaki
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - The University of Tokyo Hospital , Japan Takana Yamakawa
  • - Medicheck health care , Korea (South) Chae Lim
  • - Oita University , Japan Haruka Sato
  • - Private sector , Greece Vasilios Tzilas
  • - Niigata University , Japan Atsushi Uehara
  • - kantohrohsai hospital , Japan yoshie sato
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