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Weekly Chest CasesArchive of Old Cases

Case No : 1326 Date 2023-03-21

  • Courtesy of Bokdong Yeo, Jongmin Park, Jaekwang Lim / Kyungpook National University Hospital
  • Age/Sex 57 / M
  • Chief ComplaintIncidentally found mass density in CXR
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary lymphoma
Radiologic Findings
Fig 1. Chest PA shows mass-like consolidation in right lower and left upper lung zone.
Fig 2-5. CT scans reveal multifocal mass-like spiculated consolidation with peripheral ground glass opacity in both lungs. The consolidations showed homogeneous enhancement (average 70-80 HU) and air bronchogram. There were also multifocal small peribronchovascular nodules in both lungs. There were no significantly enlarged lymph nodes in the mediastinum nor pleural effusion.
Brief Review
Primary pulmonary lymphoma (PPL) represents a monoclonal lymphoid proliferation affecting the lungs in a patient with no detectable extrathoracic lymphoma for at least 3 months after the initial diagnosis. PPL ranges from a relatively indolent MALT lymphoma to more aggressive forms of diffuse large B-cell lymphoma. These two entities make up the majority of cases of PPL, which is overall a rare disorder. Non-Hodgkin B-cell lymphoma (NHL-B) is the most frequent type and accounts for roughly 80% of all PPL. The majority of these are MALT lymphomas, which are frequently associated with autoimmune diseases. DLBCL accounts for the majority of the other patients with PPL and it is characteristically seen in patients with underlying immunodeficiency, such as transplant patients on ciclosporin. The incidence of DLBCL may well be underestimated, as it could potentially spread rapidly from the lung into mediastinal and extrathoracic locations.
MALT lymphomas are usually asymptomatic and discovered as an incidental findings. They are typically indolent lesions and have a good prognosis. Immunocompromised patients with DLBCL are usually symptomatic with dyspnea, fever, and weight loss. Overall survival is poor and the prognosis is worse if there is an underlying disorder. Progression and relapse also occur much earlier in this group. DLBCL tends to be more diffuse and destructive, with 5-year survival rates ranging from 0–60% compared with 84–94% for MALT lymphomas.

There was a study evaluated the CT imaging findings in 21 patients with MALT lymphoma, and this group identified the following four radiological patterns of disease:
1. single nodule or single consolidative opacity (33%)
2. multiple nodules or multiple areas of consolidation (43%)
3. bronchiectasis and bronchiolitis (14%)
4. diffuse interstitial lung disease (10%).
The commonest radiological presentation of DLBCL is solitary or multiple pulmonary nodules. Cavitation is a common feature.
References
Keywords

No. of Applicants : 102

▶ Correct Answer : 44/102,  43.1%
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) HWANGHEE JO
  • - Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - , Japan FUMINORI MIYOSHI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - , Japan HIKARI FUKUI
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - , Japan YUKIKO USUI
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Korea University Guro Hospital , Korea (South) HYEJIN PARK
  • - Chonnam National University Hospital , Korea (South) GYERYEONG PARK
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Shiga University of Medical Science , Japan RYO UEMURA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , Korea (South) JIN WOO YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 28/102,  27.5%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , Japan KYOKO NAGAI
  • - Chonnam National University Hwasun Hospital , Korea (South) SEONGWOO CHO
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Italy PAOLO BALDASSARI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - , United Arab Emirates GAYATHRI GANAPATHY
  • - Osaka University , Japan AKINORI HATA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) MINJI KIM
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Presbyterian Medical Center , Korea (South) SOOYEON JEONG
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - , Japan KENTARO KOTANI
  • - Other , Korea (South) CHAEHUN LIM
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Chonbuk National University Hospital , Korea (South) SEOYUN CHOI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
▶ Semi-Correct Answer : 1/102,  1.0%
  • - Others , India PURUSHOTHAMA RAO TUMMALA
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