The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
Pulmonary and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
BMJ Case Rep. 2023 Aug 27;16(8):e254367. doi: 10.1136/bcr-2022-254367.
A female patient in her 50s presented to the hospital with a 2 months history of shortness of breath and productive cough. She also had ongoing fatigue and unintentional weight loss. Investigations demonstrated a normal white cell count and elevated lactate dehydrogenase). A CT scan of the chest revealed multiple bilateral cavitary lung masses and pulmonary nodules. Bronchoscopy with transbronchial biopsy and fine needle aspiration of mediastinal lymph node was performed. The histopathology was consistent with the non-germinal centre B cell subtype of diffuse large B cell lymphoma (DLBCL). A regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone was started, which improved her symptoms. Although a rare presentation, this case highlights the need to consider DLBCL among the differential diagnoses for cavitary lung lesions when the workup fails to elicit an alternate cause. Given its aggressive nature, prompt diagnosis and treatment are critical.
一位 50 多岁的女性患者因呼吸困难和咳痰 2 个月就诊。她还持续感到疲劳和不明原因的体重减轻。检查显示白细胞计数正常，乳酸脱氢酶升高。胸部 CT 显示多个双侧空洞性肺肿块和肺结节。进行了支气管镜检查、经支气管活检和纵隔淋巴结细针抽吸。组织病理学与非生发中心 B 细胞型弥漫性大 B 细胞淋巴瘤 (DLBCL) 一致。开始使用利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松的方案，症状得到改善。尽管这种表现较为罕见，但该病例强调了在未能确定其他病因时，对于空洞性肺病变，需要考虑 DLBCL 作为鉴别诊断之一。鉴于其侵袭性，及时诊断和治疗至关重要。
