Kanno M, Nakamura S, Uotani C, Terasaki Y, Ikeno T, Okumura H, Matano S, Hattori N, Kyoda K, Sawazaki A, Kondo Y, Minato H
Department of Internal Medicine, NTT Kanazawa Hospital.
Rinsho Ketsueki. 1999 Aug;40(8):678-84.
Most cases of primary pleural malignant lymphoma develop following chronic pyothorax. We report a case of primary pleural non-Hodgkin's lymphoma without chronic pyothorax. A 63-year-old woman was referred and admitted to our hospital with a right pleural effusion that was detected during a routine physical checkup. Her liver, spleen, and superficial lymph nodes were not palpable on physical examination. The massive right pleural effusion and a pleural mass were demonstrated on chest X-ray films and thoracic computed tomograms. Diffuse large B-cell non-Hodgkin's lymphoma was diagnosed by needle biopsy from the pleura, and the clinical stage was IE. Pleural effusion specimens contained no identifiable lymphoma cells, and examinations for Mycobacterium species were also negative. Human herpes virus 8 (HIV-8) DNA was detected in lymphocytes from the peripheral blood and pleural effusion. Epstein-Barr virus-encoded small RNAs and HHV-8 DNA were both negative in biopsied tissue from the pleural mass. Although a complete remission was achieved, the lymphoma relapsed about 8 months later. The patient is currently receiving salvage chemotherapy. Cases of primary pleural non-Hodgkin's lymphoma with massive pleural effusion that are not preceded by chronic pyothorax or Kaposi's sarcoma are very rare.
大多数原发性胸膜恶性淋巴瘤病例继发于慢性脓胸。我们报告一例无慢性脓胸的原发性胸膜非霍奇金淋巴瘤病例。一名63岁女性因在常规体检中发现右侧胸腔积液而转诊并入住我院。体格检查未触及肝脏、脾脏及浅表淋巴结。胸部X线片和胸部计算机断层扫描显示右侧大量胸腔积液及胸膜肿块。经胸膜穿刺活检诊断为弥漫性大B细胞非霍奇金淋巴瘤，临床分期为IE期。胸腔积液标本未发现可识别的淋巴瘤细胞，分枝杆菌检查也为阴性。外周血和胸腔积液淋巴细胞中检测到人类疱疹病毒8（HHV-8）DNA。胸膜肿块活检组织中EB病毒编码的小RNA和HHV-8 DNA均为阴性。尽管实现了完全缓解，但淋巴瘤约8个月后复发。该患者目前正在接受挽救性化疗。无慢性脓胸或卡波西肉瘤病史而出现大量胸腔积液的原发性胸膜非霍奇金淋巴瘤病例非常罕见。
