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Weekly Chest CasesArchive of Old Cases

Case No : 758 Date 2012-05-08

  • Courtesy of Yo Won Choi / Hanyang University
  • Age/Sex 81 / M
  • Chief ComplaintHemoptysis. History of radiation therapy for prostate cancer 9 years ago.
  • Figure 1
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  • Figure 6

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Lung involvement of diffuse large B-cell lymphoma
Radiologic Findings
Chest X-ray and CT show bronchovascular bundle thickening, ground glass opacity, fissural nodules, and multiple lung nodules which are smaller and larger than 1 cm in diameter. These nodules are predominant in the lower lung zone. PET shows multiple nodular uptakes in both lower lung zones and multiple hilar LN uptakes.

PET

Brief Review
The diagnosis was confirmed by cervical lymph node biopsy.
Primary lymphomas of MALT within the lung are rare, arising from bronchus-assoicated lymphoid tissue (BALT), which is histologically distinct from true intrapulmonary lymph nodes. Diffuse large B-cell lymphoma in the most common of the NHL. Lymphoma may involve any nodal chain in the body, and enlarged nodes are most common manifestation on CT scans. Regardless of the area of involvement, nodal involvement of lymphoma has attenuation similar to muscle and homogeneous attenuation on CT scan.
The patterns of lymphomatous involvement of the lung parenchyma are variable. In a review of the CT findings in 31 patients with pulmonary parenchymal lymphoma, the most common CT findings were nodules or mass-like consolidation larger than 1 cm (68% of patients) and small nodules less than 1cm (61%). Other manifestations include GGO, thickening of the interlobular septa, and occasionally endobronchial lesions. One pattern consists of single or multiple nodules similar to those seen in metastatic disease. The other patterns consist of mediastinal of hilar adenopathy with direct extension along lymphatic vessel into the lung parenchyma.The major difference among lymphangitic carcinomatosis, sarcoidosis, and malignant lymphoma is the greater involvement of the interlobular septa and subpleural interstitium in lymphangitic carcinomatosis than in either sarcoidosis or malignant lymphoma.
References
1. Lymphoma of the lung: CT Findings in 31 Patients. AJR 1991;156:711-714
2. Pulmonary MALT lymphoma: imaging findings in 24 cases. Eur Radiol 2000;10:1932-8
3. Comparison of High Resolution CT Findings of Sarcoidosis, Lymphoma, and Lymphangitic Carcinoma: Is There Any Difference of Involved Interstitium? J Comput Assist Tomogr 1999;23:374-9
Keywords
lung, lymphoproliferative disease,

No. of Applicants : 88

▶ Correct Answer : 4/88,  4.5%
  • - Korea university anam hospital , Korea (South) Sung-Hye You
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - NATIONAL GUARD HEALTH SERVICES , Saudi Arabia MOHAMED AHAMED
▶ Correct Answer as Differential Diagnosis : 22/88,  25.0%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun JunYeh
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - GM InHospital , Korea (South) Ju Won Lee
  • - royal melbourne hospital , Australia kimchi kings
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - CHRU Lille , France Paul Lebert
  • - Kyung Hee University Medical center , Korea (South) Myung You
  • - Montreal , Canada Drago Le King
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - IRSA , France, Metropolitan BIGOT
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Private sector , Greece Vasilios Tzilas
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
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