Primary pulmonary lymphoma--clinical review from a single institution in Singapore

Forty years literature review of primary lung lymphoma

There are several unresolved issues through out the literature regarding the entity of primary lung lymphoma. Extensive literature review of this uncommon pathology is carried out.

By taking into consideration the reported experience, the author discuss the classification, clinical features, histological differential diagnosis, prognostic criteria, therapeutic management and outcome of primary lung parenchyma lymphocytic infiltrates.

Primary pulmonary lymphoma

BACKGROUND

Primary pulmonary lymphoma is a rare disease. The clinical characteristics, methods of treatment, and outcomes are not well elucidated.

METHODS

A retrospective review of primary pulmonary lymphoma cases at a single institution from 1990 to 2002 was performed.

RESULTS

Eighteen patients were included, with a mean follow-up of 2.9 years. Fourteen patients had mucosa-associated lymphoid tissue (MALT) lymphoma, 2 had large cell transformation of sheet cells in MALT lymphoma, and 1 each had Hodgkin's disease and follicular lymphoma. Computed tomography-guided biopsy was diagnostic in only two of eight attempts. Eleven patients had disease confined to the pulmonary parenchyma, and 7 had parenchymal disease as well as mediastinal lymphadenopathy. Treatment methods included observation only (n = 1), surgery only (n = 6), surgery plus chemotherapy (n = 8), surgery plus radiotherapy (n = 1), and surgery plus chemotherapy plus radiotherapy (n = 2). Kaplan-Meier estimate of median time to disease recurrence or death was 6 years. Only 1 patient died of disease-related causes. Patients who had bilateral disease were more likely to have recurrent disease or death (p = 0.03).

CONCLUSIONS

A wide range of treatments were used for patients with generally MALT lymphoma, resulting in good outcomes, and recurrent disease was well controlled.

[Primary T-cell pulmonary lymphoma. A case report and review of the literature]

Non-Hodgkin's lymphomas rarely involve the pulmonary parenchyma. Most cases described to date involve B-cells. We report the first case of T-cell pulmonary lymphoma in the Spanish literature. The course of disease was rapid and response to treatment was poor. Such cases demonstrate the importance of open biopsy and the study of cell markers for diagnosis. T-cells lymphomas should be included in the differential diagnosis of febrile patients with pulmonary nodules.