Discussion
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,