대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 433 Date 2006-02-13

  • Courtesy of Jae Seung Seo, MD, Byoung Wook Choi, MD, Kyu Ok Ch / Shinchon Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • Age/Sex 59 / F
  • Chief ComplaintNeck pain and cough for one month Recent onset of dyspnea for five days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Non-Hodgkins Lymphoma manifesting Golden S sign
Radiologic Findings
The chest radiograph showed a right hilar bulging shadow and collapse of right upper lobe, which is known as so-called Golden S sign. Chest CT scan showed the collapse of the right upper lobe and multiple lymph nodes enlargement at right hilar area and mediastinum. The conglomerated lymph nodes at the right hilar area compressed and obstructed the right upper lobar bronchus. The lesion encased and splayed out the pulmonary vessels in the right upper lobe with mucoid impaction within the collapsed lobe.

Lymph node biopsy at the left supraclavicular fossa revealed a diffuse large B cell lymphoma with morphologic features of T-cell rich B-cell lymphoma. Immunohistochemical staining demonstrates the scattered large cells are B-cells expressing L26/CD79a (second figure as belows). Ki-1, ALK, CD10, TIA/granzyme B, CD23 and CD23 are expressed in the large cells. And the patient was in partial remission two months later after chemotherapy.
Brief Review
Golden S sign on chest radiograph has been known to be a typical sign of bronchogenic carcinomas. However, malignant lymphomas occasionally involve airway resulting in lobar or segmental collapse. Lung or airway involvement in patients with non-Hodgkins lymphoma and Hodgkins disease is unusual at the onset of the disease. Even if a malignant lymphoma shows Golden S sign on chest radiograph, like our case, the recognition of the CT findings such as the tumor infiltration encasing and splaying out the pulmonary vessels in the collapsed lung and associated multiple lymph nodes enlargement could be clues for differentiating thoracic lymphoma from bronchogenic carcinoma.
References
1. North LB, Libshitz HI, Lorigan JG. Thoracic lymphoma. Radiol Clin North Am 1990;28:745-762

2. Filly R, Bland N, Castellino RA. Radiographic distribution of intrathoracic disease in previously untreated patients with Hodgkins disease and non-Hodgkins lymphoma. Radiology 1976;120:277-281

3. Castellino RA, Blank N, Hoppe RT, Cho C. Hodgkin disease: contributions of chest CT in the initial staging evaluation. Radiology 1986;160:603-605

4. Lewis ER, Caskey CI, Fishman EK. Lymphoma of the lung: CT findings in 31 patients. AJR Am J Roentgenol 1991;156:711-714
Keywords
Mediastinum, Lung, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 31

▶ Correct Answer : 11/31,  35.5%
  • - National Taiwan University Hospital, Taiwan Yu-Feng Wei
  • - Yonsei University Hospital, Korea Eun Hye Yoo
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier Philippe
  • - Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Maimonides Medical Center; Brooklyn, New York, USA Naomi Twersky
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - Hospital Ultra Care, Coimbatore, India Dababrata Das
  • - EPM and Fleury Medical Center, Sao Paulo, Brazil Gustavo Meirelles
▶ Correct Answer as Differential Diagnosis : 14/31,  45.2%
  • - Pgimer, Chandigarh, India Ramprakash Galwa
  • - Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Doma Hospital, Damascus, Syria Mostafa Dakak
  • - Kashan Shahid Beheshti Hospital, Kashan, Iran Ebrahim Razi
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Jinju Korea Hospital, Korea Ji Hoon Park
  • - Gwangmyoung Sungae Hospital, Korea Jiyong Rhee
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Diskapi Yildirim Beyazit Hospital, Ankara, Turkey Meric Tuzun
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Annecy Hospital, France Gilles Genin
  • - Samsung Medical Center, Seoul, Korea Ha Young Kim
  • - Apollo FirstMed Hospital, Chennai, India R G Gopinath
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
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