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

Primary pulmonary lymphoma in Peru

Objective

To describe the clinical features, imaging, pathology and management of patients with primary pulmonary lymphoma (PPL).

Methodology

This is a case series study involving a retrospective analysis of 24 patients diagnosed with PPL between the years 2000-2019 at Instituto Nacional de Enfermedades Neoplásicas in Lima, Perú.

Results

73.9% of patients were male. Cough (78.3%) and weight loss (56.5%) were the most frequent clinical features. Dyspnoea and elevated values of DHL and B2 microglobulin were frequently altered in advanced stages. Diffuse large B cell lymphoma (DLBCL) represented 47.8% of the cases and the most common radiologic alterations were a mass (60%) and consolidation with air bronchogram (60%). The most utilised treatment was chemotherapy alone (60%). Three patients received only surgery. Median survival was 30 months. Five overall survival was 45%, and up to 60% in the case of mucosa-associated lymphoid tissue lymphoma.

Conclusion

PPL is infrequent. Clinical features are unspecific and the principal finding is a mass, nodule or consolidation with air bronchogram. Definitive diagnosis needs biopsy and immunohistochemistry. There is no standard treatment, it depends on histology type and stage.

Surgery and chemotherapy cannot improve the survival of patients with early-stage mucosa-associated lymphoid tissue derived primary pulmonary lymphoma

Background

To date, there is no treatment consensus on mucosa-associated lymphoid tissue (MALT) derived primary pulmonary lymphoma (PPL).

Methods

We identified patients with early-stage MALT-type PPL from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program database. The patients were divided into four groups according to treatment modalities: None of surgery or chemotherapy (None) group, Surgery alone group, Chemotherapy alone (Chemo alone) group, and Surgery plus chemotherapy (Surgery + chemo) group. Overall survival (OS) and cancer-specific survival (CSS) were study endpoints. We performed Cox regression analyses, propensity score-matched analyses (PSM) and Kaplan-Meier (KM) survival curves to compare the survival among different groups.

Results

A total of 953 patients were included in our analysis with 302, 403, 175, and 73 cases in the None, Surgery alone, Chemo alone, and Surgery + chemo groups, respectively. In this cohort, the estimated 3-year, 5-year and 10-year OS rates were 86.95%, 78.91%, and 55.89%, respectively. Meanwhile, the estimated 3-year, 5-year and 10-year CSS rates were 96.71%, 93.73%, and 86.84%, respectively. Multivariate Cox regression analyses demonstrated that increasing age, tumors located in the lower lobe, and stage II were significant predictors of poorer OS while increasing age and tumors located in the bilateral lungs were associated with lower CSS. After PSM analyses, the KM survival curves showed no significant differences in OS or CSS among the four groups.

Conclusion

Early-stage MALT-type PPL is indolent in nature. Neither surgery, chemotherapy nor a combination of surgery and chemotherapy can improve OS and CSS, suggesting that “watch and wait” may be a reasonable alternative.

Clinical Analysis of 50 Cases of Primary Pulmonary Lymphoma: A Retrospective Study and Literature Review

Objective: This study aimed at to raise the awareness understanding of primary pulmonary lymphoma (PPL) by analyzing the clinical manifestation, imaging, pathology, diagnosis, treatment, and prognostic features of 50 cases of PPL. Methods: The study of 50 individuals with PPL diagnosed at the First affiliated hospital of Nanchang university between January 2009 and December 2019 was performed. Results: Overall, 27 males and 23 females were enrolled, with an average age of 57.6 ± 15.6 years. The primary symptoms included, cough (n = 37), expectoration (n = 25), sputum with blood (n = 12), and chest pain (n = 12). Two individuals had Hodgkin's lymphoma and 48 patients had non-Hodgkin's lymphoma (NHL). We divided the NHL cases into mucosa-associated lymphoid tissue lymphoma (MALT) (n = 21), diffuse large B-cell lymphoma (n = 12), small lymphocytic lymphoma (n = 2), mantle B-cell lymphoma (n = 2), follicular lymphoma (n = 1), B-cell lymphoma without further classification (n = 8), and T-cell lymphoma (n = 2). The imaging findings revealed that unilateral lung involvement was more common among the patients. The longest follow-up duration up to December 2019 was 123 months with 40 surviving patients. The 5-year overall survival and progression-free survival were 46.7% and 44.4%, respectively. Age was an independent predictive factor for the 5-year survival (hazard ratio, 8.900; P = .038), (P < .05). Conclusion: PPL is a uncommon disease with atypical clinical manifestations and is often misdiagnosed. Immunohistochemistry is currently the standard used in pathologic evaluation of PPL. MALT prognosis is better in contrast with other kinds of PPL. Surgery or radiotherapy can be considered in patients with limited lesions, and chemotherapy is the first treatment option for diffuse lesions. Age of ≥ 60 years was reported as an independent adverse predictive factor.

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

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.

Rapidly progressing primary pulmonary lymphoma masquerading as lung infectious disease: A case report and review of the literature

BACKGROUND

Primary anaplastic large cell lymphoma of the lung represents a diagnostic challenge due to diverse manifestations and non-specific radiological findings, particularly in cases that lack extra-pulmonary manifestations and lung biopsy.

CASE SUMMARY

A 40-year-old woman presented with a 6-d history of fever, dry coughing, and dyspnea. Her white blood cell count was 20100/mm3 with 90% neutrophils. PaO2 was 60 mmHg and SaO2 was 90% when breathing ambient air. Chest computed tomography (CT) identified a solid nodule, 15 mm in diameter, with a poorly defined boundary in the upper right lung, and several smaller solid nodules throughout both lungs. Pulmonary artery CT and subsequent bedside X-ray showed diffuse patchy shadows throughout both lungs. Repeated cultures of blood samples and alveolar lavage failed to identify any pathogen. Due to the mismatch between clinical and imaging features, we conducted a bone marrow biopsy, and the results showed proliferation along all three lineages but no atypical or malignant cells. The patient received empirical antibacterial, antiviral, and antifungal treatments, as well as corticosteroids. The patient's condition deteriorated rapidly despite treatment. The patient died 6 d after hospitalization due to respiratory failure. Post-mortem lung biopsy failed to show inflammation but identified widespread infiltration of alveolar septum by anaplastic lymphoma kinase (ALK)-positive anaplastic cells.

CONCLUSION

ALK-positive anaplastic large cell lymphoma could present as a primary pulmonary disease without extra-pulmonary manifestations.