Fujioka Nobuhiro, Kai Yoshiro, Kataoka Ryosuke, Suzuki Kentaro, Sakaguchi Kazuhiro, Yamamoto Yoshifumi, Kawaguchi Takeshi, Sawabata Noriyoshi, Tanaka Haruyuki, Matsuoka Minami, Takeda Maiko, Muro Shigeo
Department of Respiratory Medicine Nara Medical University Nara Japan.
Department of Respiratory Medicine Minami-Nara General Medical Center Nara Japan.
Respirol Case Rep. 2023 Feb 22;11(3):e01111. doi: 10.1002/rcr2.1111. eCollection 2023 Mar.
Primary pulmonary diffuse large B-cell lymphoma is a rare entity. We describe a case of pulmonary lymphoma with multiple nodules mimicking metastases in a treated patient with rheumatoid arthritis. A 73-year-old man was diagnosed with rheumatoid arthritis at the age of 30. He was treated with leflunomide. He was followed up for a nontuberculous mycobacterial infection. He underwent percutaneous coronary intervention for acute myocardial infarction at the age of 70. In April 2022, routine follow-up revealed new-onset multiple nodules on chest computed tomography (CT). A position emission tomography/CT scan with 18F-fluorodeoxyglucose showed a low-high maximum standardized uptake value by multiple nodules. Pathologic examination of a video-assisted thoracic surgical biopsy revealed pulmonary diffuse large B-cell lymphoma. Systemic chemotherapy with rituximab, cyclophosphamide, vincristine, and prednisolone reduced and eliminated multiple nodules. Pulmonary lymphoma should be considered as a differential diagnosis in the case of multiple nodules on a chest CT.
原发性肺弥漫性大B细胞淋巴瘤是一种罕见的疾病。我们描述了一例在一名类风湿关节炎患者中出现多个结节、疑似转移瘤的肺淋巴瘤病例。一名73岁男性在30岁时被诊断为类风湿关节炎。他接受了来氟米特治疗。他因非结核分枝杆菌感染接受随访。他在70岁时因急性心肌梗死接受了经皮冠状动脉介入治疗。2022年4月，常规随访发现胸部计算机断层扫描（CT）出现新发多个结节。18F-氟脱氧葡萄糖正电子发射断层扫描/CT显示多个结节的最大标准化摄取值为低-高。电视辅助胸腔镜手术活检的病理检查显示为肺弥漫性大B细胞淋巴瘤。利妥昔单抗、环磷酰胺、长春新碱和泼尼松龙的全身化疗减少并消除了多个结节。在胸部CT出现多个结节的情况下，应考虑肺淋巴瘤作为鉴别诊断。
