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Chest clinic
Case based discussions
Unique radiological features of two cases of primary pulmonary diffuse large B-cell lymphoma
  1. Yuu Saitoh1,
  2. Ayae Ohnishi-Amemiya1,
  3. Michiyo Asano1,
  4. Yuko Tanaka1,
  5. Seiichiro Yoshizawa1,
  6. Hiroaki Fujimoto1,
  7. Yoshikazu Itoh1,
  8. Naoya Nakamura2,
  9. Kazuma Ohyashiki1
  1. 1 Department of Hematology, Tokyo Medical University, Tokyo, Japan
  2. 2 Department of Pathology, Tokai University, Isehara, Japan
  1. Correspondence to Dr Yuu Saitoh, Department of Hematology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; yusaitoh{at}tokyo-med.ac.jp

https://doi.org/10.1136/thoraxjnl-2017-210248

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    Introduction 

    Radiographic infiltration of the lungs by malignant lymphoma is often observed, with a reported frequency of approximately 25%. On the other hand, primary pulmonary lymphoma (PPL) is very rare. According to previous reports, PPL was observed in only 3% of patients with extranodal lymphoma, and in less than 1% of patients with non-Hodgkin's lymphoma. Most cases of PPL (58%–87%) are marginal zone lymphomas of the mucosa-associated lymphoid tissue (MALT) type.1 However, primary lung diffuse large B-cell lymphoma (DLBCL) is rare (10%).2 Here we present two cases of primary lung DLBCL displaying unique imaging.

    Case report

    Case 1

    A 56-year-old woman complaining of dyspnoea and fever was admitted to our hospital. Consolidation in the bilateral upper fields on chest radiological examination and multiple pulmonary nodules on CT were the only abnormalities detected by radiography (Figure 1A).

    Upper and lower endoscopy showed no evidence of gastrointestinal cancer. A trans-bronchial lung biopsy (TBLB) was subsequently performed for histopathological analysis. Haematoxylin and eosin staining of tissue sections showed diffuse and monotonous proliferation of large round cells, in the form of sheets within interstitial lung tissue (Figure 1B). Immunohistochemical staining demonstrated that the …

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    Footnotes

    • Contributors YS treated patients, and wrote the initial draft of the manuscript. KO and YT contributed to assist in the preparation of the manuscript. All other authors have contributed to treat patiens and interpretation, and critically reviewed the manuscript. The final version of the manuscript was approved by all authors.

    • Competing interests KO received grants from Chugai pharma, Novartis pharma KK, Bristol-Myers Squibb, Celegen, Jansen pharma, and personal fees from Novartis pharma, Bristol-Myers Squibb, Celegen, Nippon Shinyaku, Dainippon Sumitomo, Fujirebio, Phizer, Jansen pharma, Taiho pharma, Otsuka pharma, Alexion, MSD, Kyowa Hakko Kirin, outside the submitted work.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.