Pulmonary non-Hodgkin Lymphoma Research Articles

Primary Non-Hodgkin Lymphoma Lung

Lymphomas are a heterogeneous group of malignancies that originate from the neoplastic transformation of lymphocytes. Primary pulmonary non-Hodgkin lymphoma is a rare entity with marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) which is the most common subtype is a low-grade lymphoma accounting for <0.5% of all primary lung neoplasms. The most common presentation is a mass discovered on a chest radiograph in an asymptomatic patient, with symptomatic patients presenting with cough, dyspnea, chest pain, and hemoptysis. On computerized tomography, multiple bilateral lesions are commonly seen in pulmonary MALT lymphoma with consolidation, nodule, and mass being the main morphological patterns. We present two cases diagnosed with marginal zone lymphoma of the lung which is an indolent lymphoma and the most common subtype in the lung.

Primary Pulmonary Small B-Cell Non-Hodgkin Lymphoma -Case Presentation-

Abstract Primary pulmonary non-Hodgkin lymphoma is a rare entity, accounting for 3-4% of extranodal non-Hodgkin lymphomas. Indolent primary pulmonary non-Hodgkin lymphomas are the most frequent types, with the MALT subtype representing majority of cases. Other indolent subtypes of B-cell primary pulmonary lymphomas are rare. We present the case of a 56-year-old patient, non-smoker, who presents for pain in the right hemithorax, worsened by deep inhales. Pulmonary X-ray showed a right paramediastinal superior and medial lobe homogenous opacity with faded contour. Thoracic computed tomography scan described a dense right superior mediastino-pulmonary tumoral mass, the absence of hilar or mediastinal adenopathies. In this context, an ultrasound-guided transbronchial needle aspiration was performed. Histopathology and immunohistochemistry confirmed the diagnosis of primary pulmonary small B-cell non-Hodgkin lymphoma. After 6 chemotherapy cycles, from a clinical and imagistic (thoracic CT scan) point of view, the response was favourable. Positron emission tomography (PET/CT) aspect indicated a complete metabolic response to treatment.

Primary pulmonary lymphoma from bronchus-associated lymphoid tissue (clinical observation)

Purpose. To describe the clinical case of rare indolent extranodal non-Hodgkin’s lymphoma, which originates from bronchus-associated lymphoid tissue, and to analyze the main current trends in the diagnosis and treatment of this pathology.Using bibliosemantic and analytical methods of research in modern scientific literature, we analyzed the main historical data and clinical-radiological and immunomorphological criteria for the diagnosis of casuistically rare neoplasm – the primary pulmonary non-Hodgkin's lymphoma – the indolent extranodal B-cell lymphoma of the marginal zone, arising from the bronchus-associated lymphoid tissue (BALT). The prevalence of BALT-lymphoma is less than 0.5 % of all pulmonary malignant tumors and less than 1 % of all non-Hodgkin’s lymphomas. Nowadays, diagnostic approaches and standard systemic treatment of this disease are still widely discussed. The recommendations of the retrospective international study of primary extranodal lymphoma of lungs from the marginal zone conducted by the international extranodal lymphoma study group (IELSG) are presented and the main recommendations of the NCCN for the diagnosis and treatment of mucosa-associated lymphoma (2019) are analyzed. Treatment options for BALT-lymphomas vary in the range from antibiotic therapy and clinical observation to surgical resection or combination with chemotherapy and radiotherapy, but optimal therapy for the disease needs further study. It is noted that precise morphological definition and immunohistochemical phenotyping allow choosing an adequate protocol for chemo-therapeutic treatment (immunochemotherapy). The main options for radical surgical, chemo-therapeutic and radiological stages of BALT-lymphoma treatment and indications for their combined use within the framework of the multidisciplinary approach to treatment with lymphomas are discussed and their effectiveness is determined. The actual 4-year clinical observation of 48 year old patient with BALT-lymphoma is presented and the main radiological diagnostic criteria and difficulties of morphological diagnostics and immunohistochemical phenotyping are discussed. The above clinical observation is aimed at information of a wide range of practicing doctors – therapists, pulmonologists, phthisiologists, thoracic surgeons, oncologists, radiologists.Conclusions. BALT-lymphoma is a rare form of extranodal non-Hodgkin’s lymphoma, that does not have clear clinical guidelines and specific radiological signs and requires well-balanced histological diagnostics and immunohistochemical verification, which, in combination with computed tomography (PET-CT) methods, determines the stage of the disease and, respectively, tactics for the management of patients.

Diagnostic and prognostic factors for patients with primary pulmonary non-Hodgkin's lymphoma: A 16-year single-center retrospective study.

Primary pulmonary non-Hodgkin's lymphoma (PP-NHL) is a rare entity with non-specific symptoms and radiographic findings, as well as a difficult preoperative diagnosis. A limited number of studies have described PP-NHL in Chinese patients. The goal of the present study was to improve early diagnosis by examining prognostic factors in patients with PP-NHL. Therefore, a total of 29 patients with PP-NHL were included in the study between January 2001 and June 2017, including 14 with aggressive-type and 15 with indolent-type lymphomas (10 male, 19 female; median age, 50.3 years; range, 19-87 years). Pulmonary nodules and masses (55.2%) were the most common radiographic features. The diagnostic yield was 80% (12/15) by endobronchial biopsy or transbronchial lung biopsy and 100% by computed tomography (CT)-guided percutaneous needle lung biopsy (11/11) or surgery (8/8). Elevated lactate dehydrogenase levels and systemic symptoms were observed considerably more often in patients with aggressive disease than in those with indolent disease. The 1-, 3- and 5-year overall survival (OS) rates were 42, 32, and 21%, respectively, for all patients, 72, 57 and 43%, respectively, for patients with indolent lymphomas, and 13, 6 and 0%, respectively, for patients with aggressive lymphomas. The median OS rate for all patients was 12.0 months; however, the OS rate for patients with aggressive lymphomas was significantly shorter compared with those with indolent lymphomas (7.1 months vs. 16.6 months; P=0.002). Aggressive vs. indolent lymphoma status was indicated to be an independent prognostic factor for poor 5-year OS rate (hazard ratio, 5.98; P=0.014). In conclusion, bronchoscopic and CT-guided percutaneous needle lung biopsies were the most useful and least invasive procedures for diagnosing PP-NHL. Furthermore, aggressive PP-NHL was highly associated with poor 5-year OS rate and a poor prognosis.

The impact of early diagnosis on the prognosis of extranodal NK/T-cell lymphoma with massive lung involvement: a case report

BackgroundPulmonary non-Hodgkin lymphoma (NHL) is rare. The most frequent subtype of pulmonary NHL is low-grade B-cell lymphoma, such as lymphoma of mucosa-associated lymphoma tissue. Extranodal natural killer cell/T-cell lymphoma, nasal type (ENKL) is characterized by predominant extranodal involvement and association with Epstein-Barr virus (EBV). ENKL with massive lung involvement has been infrequently reported, and its prognosis is extremely poor.Case presentationA 20-year-old Japanese man presented with intermittent fever lasting for 2 months. Radiological imaging demonstrated multiple nodules of uneven shape and size in both lungs. Video-assisted thoracic surgical lung biopsy showed abnormal lymphocyte infiltration, which was positive for CD3, CD56, and perforin. In situ hybridization for EBV-encoded RNA was positive. From these findings, he was diagnosed with ENKL with lung involvement. The patient was successfully treated with intensive combinational chemotherapy followed by allogeneic cord blood transplantation. He has been alive with continuous complete remission for 1 year after diagnosis.ConclusionsAlthough ENKL involving the lung has been reported to have dismal outcomes, our patient showed long-term survival after intensive chemotherapy and up-front allogeneic hematopoietic transplantation. The present case highlights the importance of early diagnosis as well as allogeneic transplantation.

Flow cytometry analysis of lymphocyte subsets in bronchoalveolar lavage: comparison between lung non-Hodgkin lymphomas and reactive diseases

Deepened flow cytometry (FCM) analysis of bronchoalveolar lavage fluid (BALF) cells can disclose clonal B and abnormal T lymphocytes in case of lung involvement in non Hodgkin lymphoma (NHL). The possible role of routine FCM BALF analysis in diagnosing NHL involving the lungs is largely undetermined. To evaluate whether differences exist, within FCM screening of lymphocyte subsets, between BALFs from lung NHL and BALFs from reactive diseases. We compared alveolar leukocyte and lymphocyte data obtained using flow cytometry in 17 lung NHL cases with the median corresponding data detected in 208 controls, matched with cases for computed tomography findings. Absolute leukocyte counts did not differ significantly between cases and controls. As calculated within leukocytes, percentages of total, B, T, CD4+ and CD8+ T lymphocytes, respectively, were significantly higher in B cell NHL cases than in their controls (P = .003, .023, .009, .004, and .020, respectively). Similarly, percentages of total, and CD8+ T lymphocytes, respectively, were significantly higher in T cell NHL cases than in their controls (P = .046 and .027, respectively). Huger BALF lymphocytosis occurs in pulmonary NHLs than in other lung diseases. Possible lymphocyte cutoffs, that could indicate lung NHL and the subsequent need of a second-step BALF staining shortly following the initial screening, should be prospectively attempted.

Coincidental Observation of Global Hypometabolism in the Brain on PET/CT of an AIDS Patient With High-Grade Pulmonary Non-Hodgkin Lymphoma

AIDS-related dementia complex is the most severe form of cognitive dysfunction in a patient infected with human immunodeficiency virus. The use of FDG PET/CT to diagnose AIDS-related dementia complex has been studied previously and shows various specific metabolic patterns from striatal hypermetabolism in early asymptomatic stage to global hypometabolism in advanced stages. We present a case of a 49-year-old patient with long-standing human immunodeficiency virus infection, where global brain hypometabolism was noted coincidentally on FDG PET/CT done for initial staging of primary pulmonary non-Hodgkin lymphoma.

Clinical analysis of 19 patients with primary pulmonary non-Hodgkin lymphoma

Objective To discuss the diagnosis, treatment and prognostic factors of primary pulmonary non-Hodgkin lymphoma (PPNHL). Methods A retrospective analysis was performed on the clinical data of 19 patients from January 2000 to October 2014, who was diagnosed as PPNHL in Henan Cancer Hospital with complete data. The Kaplan-Meier method and Log-rank test were used in the survival analysis and the difference analysis, respectively. Results There were 13 patients with primary pulmonary mucosa-associated lymphoid tissue (PPMALT) lymphoma in the group and the others were non-PPMALT lymphoma. The 5-year overall survival rate of the 19 patients was 72.3 %, among which patients with PPMALT lymphoma or non-PPMALT lymphoma had statistically significance (83.3 % vs 50.0 %, P= 0.047). Conclusions PPNHL is very rare, lacking specificity of its clinical manifestations and imaging findings. Pathology and immunohistochemistry are important to its diagnosis. Though PPNHL lacks uniform treatment programs, most of them are MALT lymphoma with good prognosis. Key words: Lymphoma, non-Hodgkin; Lung; Diagnosis; Therapy

Primary extranodal natural killer/T-cell lymphoma of bronchus and lung: A case report and review of literature.

Primary pulmonary non-Hodgkin's lymphoma (NHL) is very rare. It represents less than 1% of all NHL, and 0.5-1% of all primary pulmonary malignancies. Almost all cases of primary pulmonary NHL originate from B-cell lineage. We present a case of a 53-year-old man with primary extranodal NK/T-cell lymphoma of the bronchus and lung, presented progressive dyspnea caused by right lower lung consolidation, and pleural effusion. Initial chest computed tomography suggested advanced lung cancer. Bronchofiberscopy showed a polypoid tumor on which a biopsy was performed. Histologically, the diffusely infiltrative atypical cells were positive for cytoplasmic CD3, CD56, granzyme B, and negative for cytokeratin, CD20 immunostains, suggesting NK/T cell lineages. In situ hybridization for Epstein-Barr virus encoded ribonucleic acid (EBER) was positive. Herein, we discuss the clinicopathological features of this case and review the literature on primary extranodal NK/T-cell lymphoma of the lung. Compared with other patients, who died after the first cycle of chemotherapy and/or within three months, our patient had longer survival under aggressive chemotherapy and auto-peripheral blood stem cell transplantation.

A 54-Year-Old Man Referred With Nonresolving Pneumonia

A 54-year-old man was referred with nonresolving pneumonia. He had been treated for community-acquired pneumonia 6 weeks earlier. He reported grade 2 dyspnea, malaise, and a nonproductive cough. He had also experienced three episodes of minimal hemoptysis but denied weight loss, fever, or any other constitutional symptoms. He was a nonsmoker and was being treated for dyslipidemia.

Primary pulmonary lymphoma: About five cases and literature review

Primary pulmonary lymphoma is a very rare neoplasm that represents only 3-4% of extranodal non-Hodgkin lymphoma (NHL), less than 1% of NHL and only 0.5-1% of primary pulmonary malignancies. Primary pulmonary NHL is most commonly represented by marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma). The clinical characteristics, methods of treatment, and outcomes are not well-elucidated. We, therefore, reviewed the medical records of five Moroccan patients who were pathologically and clinically diagnosed as primary pulmonary lymphoma and treated in our institute of oncology.

Clinical and radiological features of primary pulmonary non-Hodgkin lymphoma

Clinical and radiological features of primary pulmonary non-Hodgkin lymphoma

Primary pulmonary non-Hodgkin's lymphoma: Case report

Primary pulmonary non-Hodgkin's lymphoma: Case report

A Case of Synchronous Lung Adenocarcinoma and Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue Type

Abstract SESSION TYPE: Cancer Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Extranodal marginal zone B-cell lymphoma (extranodal MZL) of mucosa-associated lymphoid tissue (MALT) type, also called MALT lymphoma, is a distinct subgroup of non-Hodgkin's lymphoma (NHL). More than two thirds of primary pulmonary NHLs are extranodal MZLs but they account for less than 0.5% of all primary lung neoplasms. Only a few cases of simultaneous lung cancer and pulmonary extranodal MZL have been reported. Also, it is extremely rare that primary extranodal MZL occurs in the large airways. To our knowledge, only one case of lung cancer coexisting with extranodal MZL of the large airway has been reported. We report a case of synchronous lung adenocarcinoma and primary extranodal MZL of the left main bronchus.CASE PRESENTATION: A 60-year old woman was referred to our hospital with a pulmonary nodule in the right upper lung seen on chest radiograph during a routine health checkup. She had never smoked. A chest radiograph showed a nodule in the right upper lung. A chest computed tomographic (CT) scan showed a peripherally located 2.4 × 1.8 cm sized solid nodule in the anterior segment of the right upper lobe. Fluorine 18-labeled fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT scan revealed abnormal FDG uptake in the right upper lobe lung nodule and in the right hilar lymph node. She underwent CT image-guided percutaneous core needle biopsy of the nodule in the right upper lobe. Additionally, a flexible bronchoscopic examination was performed to identify the endobronchial lesion. At bronchoscopy, a few small variable-sized protrusions were observed in the proximal left main bronchus and a biopsy was performed . The needle biopsy specimens of the right lung nodule showed non-mucinous adenocarcinoma. Immunohistochemical stains were positive for CK7 and TTF-1, and negative for CK20. Histopathology of the bronchoscopic biopsy specimens of the left main bronchus lesions showed diffuse proliferation of atypical lymphoid cells beneath the mucosal epithelium. Immunohistochemical stains showed diffuse strong positive for CD20, and were negative for CKpan and CD10. The bronchial lesion was diagnosed as extranodal marginal zone B-cell lymphoma of MALT type. She underwent right upper lobectomy and lymph node dissection for the lung adenocarcinoma. However, she did not receive specialized therapy for extranodal MZL of the left main bronchus. Since then she has been observed regularly.DISCUSSION: Synchronous primary malignancy and extranodal MZL in the same anatomical sites, such as stomach and lung is very unusual. To our knowledge, there is only one other report showing the coexistence of lung cancer and pulmonary extranodal MZL of the large airway. However, in that case, the histology of lung cancer was squamous cell carcinoma. The present case is the first report of the simultaneous occurrence of lung adenocarcinoma and pulmonary extranodal MZL of the large airway. The cause of the synchronous lesions in our case is uncertain. We postulate that a pulmonary extranodal MZL may coincide with a lung adenocarcinoma by accident. Little is known about the mechanism of the simultaneous occurrence of these different tumors. Moreover, the two different malignancies were located in different lungs in this case. However, other possible causes may include common etiologic factors and genetic or epigenetic alterations participating in the development of both the lung adenocarcinoma and extranodal MZL. Further studies will be required to clarify the relationship between lung adenocarcinoma and pulmonary extranodal MZL. It is necessary to accumulate more cases with both malignancies.CONCLUSIONS: In conclusion, we report a unique case of pulmonary extranodal MZL of main bronchus coexisting with lung adenocarcinoma. The patient was asymptomatic and was diagnosed with pulmonary extranodal MZL by chance during investigation of an endobronchial lesion.1) Jaffe ES, Harris NL, Stein H, Vardiman JW. World Health Organization Classification of Tumors. Pathology and Genetics of Tumors of Haematopoietic and Lymphoid tissue. Lyon: International Agency for Research on Cancer; 2001.DISCLOSURE: The following authors have nothing to disclose: Chi Young Jung, Young June JeonNo Product/Research Disclosure InformationKeimyung University Dongsan Hospital, Daegu, Republic of Korea.

Primary pulmonary non-Hodgkin’s lymphoma: ten cases with a review of the literature

Primary pulmonary non-Hodgkin's lymphoma (PPNHL) of the lung occurs very rarely. To clarify clinical features, treatment alternatives and outcomes, we evaluated our surgically diagnosed PPNHL cases. A retrospective review of PPNHL cases from January 2004 to December 2009 was performed. Demographic and clinical data are presented as means or medians. Overall survival was estimated using the Kaplan-Meier method. Survival rates were compared using the log-rank test. A p value < 0.05 was considered significant. Patients were eight males and two females with a median age of 50 years (range, 29-76 years). In 40% of the patients, antigenic stimulation, immune-suppression or auto-immune disease could not been found. All patients were symptomatic at presentation. Surgical procedures were needed to obtain a diagnosis (nine wedge resections and one pneumonectomy). Eight patients had an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), and two had diffuse large B-cell lymphomas. The patients were treated with observation (pneumonectomy case), chemotherapy (n= 7), and chemotherapy and radiotherapy (n= 1). Five-year survival was 76%. Difference in survival rates of patients with bilateral vs. unilateral disease were not statistically different. On contrary of the literature, PPNHL can occur with absence of antigenic stimulation, and patients generally have some symptoms. Chemotherapy or surgery can be used to treat PPNHL. Patient survival is good.

Linfoma pulmonar primario no Hodgkin con infiltración de miocardio

A case of primary pulmonary non-Hodgkin's lymphoma is presented. On this occasion, the lymphoma invaded the myocardium, an event which has not previously been reported in the literature. These neoplasms spread by proximity, and invasion of the pericardium, thoracic wall and oesophagus have been described. Our patient died from heart failure. Tumour myocardial infiltration may well have been the determinant cause through various mechanisms, including a decrease in myocardial contractility. Spread into the myocardium may be facilitated by bulky tumour infiltrates in the pleural space.

Primary pulmonary non‐Hodgkin's lymphoma: A retrospective analysis of 29 cases in a Chinese population

Primary pulmonary non-Hodgkin's lymphoma (PPL) is a rare extranodal lymphoid neoplasm. The present knowledge of this entity is vague and minimal. A total of 29 patients diagnosed with PPL at Sun Yat-Sen University Cancer Center in China were retrospectively analyzed. Nineteen patients had mucosa-associated lymphoid tissue (MALT) lymphoma, nine had diffuse large B-cell lymphoma (DLBCL), and one had plasmacytic lymphoma. Six patients received PET/CT scans before treatment, and mean maximum standardized uptake values (mSUVs) were much higher in the DLBCL cases (n = 3) than in the MALT lymphoma cases (n = 3). The 3-year overall survival (OS) rate was 79.3%. Cox regression analysis showed that hilar/mediastinal lymphadenopathy (LAP) was an independent predictor of survival (P = 0.029). The mean survival time (MST) was 75.5 months for patients who underwent surgery and 65.7 months for those who didn't (P = 0.38). The MST was 77.4 months for patients treated with rituximab and 54.1 months for those not treated with rituximab (P = 0.101). Clinical characteristics in our study were partly similar to those previously reported. However, we found that hilar/mediastinal LAP seemed to be an effective prognostic factor in Chinese PPL patients. The role of surgery and rituximab in the management of PPL warrants further investigation.

Pulmonary non-Hodgkin’s lymphoma developed during long-term methotrexate therapy for rheumatoid arthritis

Methotrexate is effective in treating rheumatoid arthritis (RA). Some reports have discussed the possible association between methotrexate and lymphoma. Here, we report a case of pulmonary non-Hodgkin's lymphoma (NHL) developed after 11 years' methotrexate therapy for RA. Biopsy of the pulmonary mass demonstrated a diffuse large B-cell lymphoma. After withdrawal of methotrexate without any other intervention for 4 weeks, a significant reduction in the size of the lymphoma was observed. The causative relationship between methotrexate and pulmonary lymphoma is suggested by the persistent remission after stopping methotrexate therapy.

Clinical Feature of Primary Pulmonary Non-Hodgkin's Lymphoma

【Background: Primary non-Hodgkin's lymphoma of the lung is a rare entity. It is represented commonly as marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. Although there have been a few reviews of this lymphoma, clinical features, radiologic findings, management and prognosis have not been well defined. Methods: We reviewed the medical records of 24 patients with primary pulmonary lymphoma between January 1995 and September 2008; all diagnoses had been confirmed based on pathology. Results: The median follow-up time was 42.3 months (range, 0.1~131.2 months). Five (20.8%) patients were asymptomatic, 17 (70.8%) patients had pulmonary symptoms, and the remaining 2 (8.3%) patients presented with constitutional symptoms. There were 16 (66.7%) patients with MALT lymphoma, 4 (16.7%) patients with diffuse large B-cell lymphoma and 4 (16.7%) patients with lymphoma that had not received a WHO classification. Radiologic findings of primary pulmonary lymphoma were diverse and multiple nodule or consolidation was the most common finding regardless of pathologic lymphoma type. PET scan was carried out in 13 (54.2%) patients and all lesions showed notable FDG uptake. MALT lymphoma showed a trend of better prognosis (3-year survival, 78.8% vs. 70.0%; 5-year survival, 78.8% vs. 52.5%; p=0.310) than non-MALT lymphoma. Conclusion: Primary non-Hodgkin's lymphoma of the lung occurs with nonspecific clinical features and radiologic findings. MALT lymphoma is the most common pathologic type of primary pulmonary lymphoma. This entity of lymphoma appears to have a good prognosis and in this study, there was a trend of better outcome than non-MALT lymphoma.】

Pulmonary non‐Hodgkin's lymphoma (NHL) of diffuse large B‐cell type with simultaneous humeral involvement in a young lady: An uncommon presentation with cytologic implications

A bronchogenic carcinoma, almost invariably, presents as a lung mass. Primary pulmonary lymphomas are rare. We report an unusual case of a pulmonary non-Hodgkin's lymphoma (NHL) with simultaneous involvement of the right humerus in a 37 year old lady. Bronchial lavage smears showed atypical cells with irregular nuclear membranes raising a suspicion of a hematolymphoid tumor, over a small cell carcinoma that was the closest differential diagnosis. Biopsy from the lung mass and from the lesion in the humerus showed an identical malignant round cell tumor with prominent apoptosis. On immunohistochemistry (IHC), tumor cells were diffusely positive for leukocyte common antigen (LCA), CD20 and MIB1 (70%), while negative for cytokeratin (CK), epithelial membrane antigen (EMA) synaptophysin, chromogranin, neuron specific enolase (NSE), CD3, and CD10. Diagnosis of a pulmonary NHL of diffuse large B-cell type with involvement of the humerus was formed. The case is presented to create an index of suspicion for the possibility of a NHL on respiratory samples, while dealing with small round cells with irregular nuclear membranes. IHC is necessary to confirm he diagnosis. A simultaneous association in the humerus in our case makes it unusual.