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Weekly Chest CasesArchive of Old Cases

Case No : 581 Date 2008-12-15

  • Courtesy of Jeong Geun Yi, MD. / Konkuk University Hospital, Korea.
  • Age/Sex 59 / M
  • Chief ComplaintRight lower quadrant pain and mass for 1 month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Diffuse large B cell lymphoma involving, left thyroid, right lung and terminal ileum. (tissues confirmed in all three areas)
Radiologic Findings
Chest radiograph shows fibrostreaky density on left upper lobe which suggests stable tuberculosis. At CT scan, there is a nodule with pseudocavity in right lower lobe. Thyroid ultrasound was done for evaluation of low density nodule which was found on CT. At ultrasound, the nodule is about 15 mm in size and with well-defined smooth border which is predominantly cystic and with hypoechoic debris This is indeterminate findings for malignancy. Abdomen CT shows circumferential wall mass at ileum without obstruction. PET-CT, MIP imaging shows three FDG-avid lesions in left thyroid, right lung and right lower abdomen with SUVmax of 5, 12 and 28 each.
Brief Review
Lymphomas are a diverse group of neoplastic disorders. They are divided into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and further subdivisions depend on the histologic types. The presence and distribution of thoracic involvement are important in both tumor staging and treatment, especially when radiation therapy is planned. Intrathoracic involvement is commoner in HL than NHL. Although HL represents only 10% to 15% of all cases of lymphomas, approximately 85% of patients with HL have intrathoracic disease at presentation. NHL represents about 85% to 90% of all cases of lymphoma and approximately 40% to 45% of patients with NHL have intrathoracic disease at the initial presentation. Although HL and NHL may have overlapping imaging findings, there are some significant differences in their radiologic features.

NHL has a worse prognosis than HD. Unlike HD, which commonly spreads through contiguous groups of lymph nodes, NHL is infrequently localized at the time of diagnosis and frequently involves extranodal sites of disease. NHL can be divided into two groups: indolent lymphomas, which grow more slowly and have fewer symptoms (eg, follicular lymphoma, MALT), and aggressive lymphomas, which grow more quickly (eg, diffuse large cell lymphoma, Burkitt's lymphoma, Mantle cell lymphoma).

Diffuse large B-cell lymphoma is the most common of the non-Hodgkin lymphomas, accounting for up to 30 percent of newly diagnosed cases. Diffuse large B-cell lymphoma is an aggressive, or fast-growing lymphoma. It can arise in lymph nodes or outside of the lymphatic system, in the gastrointestinal tract, testes, thyroid, skin, breast, bone or brain. Often, the first sign of diffuse large B-cell lymphoma is a painless or even painful rapid swelling in the neck, armpit or groin caused by enlarged lymph nodes. Other symptoms include night sweats, unexplained fevers and weight loss.
References
1. Bae YA, Lee KS. Cross sectional evaluation of thoracic lymphoma. Radiol Clin North Am. 2008 Mar;46(2):253-64
2. Rademaker J. Hodgkin's and Non-Hodgkin's lymphomas. Radiol Clin North Am. 2007 Jan;45(1):69-83.
Keywords
Lung, Multiple organ, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 74

▶ Correct Answer : 30/74,  40.5%
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - SPS APOLLO HOSPITALS , India LOVKESH MITTAL
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Osaka University , Japan Osamu Honda
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - second hospital xian jiaotong university , China li ming
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - Saga University , Japan Ryoko Egashira
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Asan Medical Center , Korea (South) Jae-Woo Song
  • - KHD , Turkey Tay Bakar
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Mallinckrodt Institute of Radiology , United States Travis Henry
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - KMC,Manipal , India satish maddukuri
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Changi General Hospital , Singapore Angeline Poh
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - UZ Gent , Belgium Robert Gosselin
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
▶ Correct Answer as Differential Diagnosis : 17/74,  23.0%
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Ruby Hall Clinic , India john joseph
  • - KONARK DIAGNOSTIC CENTRE , India AHAMAD MUKARRAB
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - wonju christial hospital , Korea (South) Daekeon Lim
  • - CHRU lille , France manuel toledano
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
▶ Semi-Correct Answer : 2/74,  2.7%
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
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