Dong Nian, Jin Yi, Li Yuping, Ye Junru
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China.
Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China.
Int J Clin Exp Pathol. 2020 Aug 1;13(8):2181-2186. eCollection 2020.
Primary pulmonary lymphoma is a rare clinical neoplasm, and its atypical manifestation frequently leads to misdiagnosis. Here, we have reported a rare case of a 55-year-old man who presented with cough, dizziness, and fatigue. His chest computed tomography (CT) revealed diffuse ground glass pulmonary opacities. Bronchoscope lavage demonstrated lymphocyte predominance, while transbronchial biopsy indicated chronic inflammation. The administration of a broad-spectrum antibiotic regime supplemented with a high dosage of methylprednisolone was ineffective in improving the general condition of the patient, and the diffuse ground glass pulmonary opacities continued to worsen. CT-guided percutaneous lung biopsy confirmed the diagnosis of primary pulmonary lymphoma-diffuse large B-cell (PPL-DLBCL) without extrapulmonary involvement. The patient's general condition improved with the systemic chemotherapy of CHOP. In the context of a systemic review of relevant literature, pulmonary lymphoma should be considered in the differential diagnosis of diffuse ground glass pulmonary opacities, and bronchoscopy is recommended for pathological diagnosis. Moreover, CT-guided percutaneous lung biopsy should also be adopted whenever necessary.
原发性肺淋巴瘤是一种罕见的临床肿瘤,其非典型表现常导致误诊。在此,我们报告了一例罕见病例,一名55岁男性,表现为咳嗽、头晕和乏力。他的胸部计算机断层扫描(CT)显示双肺弥漫性磨玻璃样混浊。支气管镜灌洗显示淋巴细胞为主,而经支气管活检提示慢性炎症。给予广谱抗生素联合大剂量甲泼尼龙治疗未能改善患者的一般状况,双肺弥漫性磨玻璃样混浊持续加重。CT引导下经皮肺穿刺活检确诊为无肺外受累的原发性肺淋巴瘤-弥漫大B细胞型(PPL-DLBCL)。患者接受CHOP全身化疗后一般状况改善。在对相关文献进行系统综述的背景下,在双肺弥漫性磨玻璃样混浊的鉴别诊断中应考虑肺淋巴瘤,建议行支气管镜检查以明确病理诊断。此外,必要时也应采用CT引导下经皮肺穿刺活检。