82 Primary Pulmonary Lymphoma

CASE 82


image Clinical Presentation


Asymptomatic 71-year-old man evaluated because of an abnormal chest radiograph


image Radiologic Findings


PA chest radiograph (Fig. 82.1) demonstrates multi-focal bilateral nodular opacities without associated lymphadenopathy or pleural effusion. Unenhanced chest CT (lung window) (Fig. 82.2) shows multi-focal subpleural nodular opacities of heterogeneous attenuation. Biopsy confirmed the diagnosis of primary pulmonary lymphoma of mucosa-associated lymphoid tissue (MALT). PA chest radiograph (Fig. 82.3) obtained three years later demonstrates interval growth and coalescence of multi-focal nodular opacities. Unenhanced chest CT (lung window) (Fig. 82.4) confirms interval growth of pulmonary lesions, which exhibit internal air bronchograms.


image Diagnosis


Primary Pulmonary Lymphoma; Marginal Zone B-Cell Lymphoma of MALT


image Differential Diagnosis


• Multicentric Lung Cancer


• Pulmonary Metastases


• Multi-focal Pneumonia


• Cryptogenic Organizing Pneumonia



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Fig. 82.1



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Fig. 82.2




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Fig. 82.3



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Fig. 82.4


image Discussion


Background


Pulmonary lymphomas are subdivided into those lymphomas limited to the lung (primary) and those in which the lung is affected secondarily. A primary pulmonary lymphoma is defined as an extranodal pulmonary lymphoma without evidence of extrapulmonary involvement at diagnosis and during the subsequent three months. It is a rare lung malignancy and comprises approximately 0.5% of all primary lung neoplasms. Most (70–90%) primary pulmonary lymphomas are marginal zone lymphomas of MALT. Primary pulmonary diffuse large B-cell lymphomas account for approximately 5–20% of all primary pulmonary lymphomas. A secondary pulmonary lymphoma is much more frequent, occurs in approximately 50% of patients with lymphoma, and is more common in patients with Hodgkin lymphoma.


Etiology


Primary pulmonary lymphomas

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Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on 82 Primary Pulmonary Lymphoma
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