Huan Nai-Chien, Ng Khai Lip, Nyanti Larry Ellee, Khaw Jing Yi, Lee Jiun Hang, Mohd Aminudin Nur Husna, Yunus Dahziela, Azman Nusaibah, Ahmad Sharifuddin Maryam, Ramarmuty Hema Yamini, Sivaraman Kannan Kunji Kannan
Department of Respiratory Medicine Queen Elizabeth Hospital Kota Kinabalu Malaysia.
Department of Medicine Melaka Hospital Melaka Malaysia.
Respirol Case Rep. 2024 Nov 19;12(11):e70061. doi: 10.1002/rcr2.70061. eCollection 2024 Nov.
A third of patients with non-Hodgkin's lymphoma (NHL) develop pleural effusion during the disease course for various reasons. In most cases, lymphoma-related pleural effusion is a manifestation of widespread systemic disease, signifying a high tumour burden and therefore, a poorer prognosis. On the other hand, primary pleural lymphomas (PPLs) exhibit exclusive or dominant involvement of serous cavities, without detectable solid tumour masses. PPL is an uncommon disease and is of two types: primary effusion lymphoma (PEL) and diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI). PPLs not related to PELs and DLBCL-CIs are exceedingly rare. Herein, we describe four patients with biopsy proven B-cell NHL. One had no extra-pleural involvement at the time of diagnosis, indicating PPL. In all cases, histopathological examination of pleural biopsies obtained via medical thoracoscopy (MT) were crucial in clinching the final diagnosis. Clinicians are alerted to the potential relationship between exudative effusion and NHL as well as the role of MT in the diagnosis of B-cell NHL.
三分之一的非霍奇金淋巴瘤（NHL）患者在病程中会因各种原因出现胸腔积液。在大多数情况下，淋巴瘤相关的胸腔积液是广泛系统性疾病的一种表现，意味着肿瘤负荷高，因此预后较差。另一方面，原发性胸膜淋巴瘤（PPL）表现为浆液腔的排他性或主要受累，无可检测到的实体肿瘤肿块。PPL是一种罕见疾病，有两种类型：原发性渗出性淋巴瘤（PEL）和与慢性炎症相关的弥漫性大B细胞淋巴瘤（DLBCL-CI）。与PEL和DLBCL-CI无关的PPL极为罕见。在此，我们描述了4例经活检证实为B细胞NHL的患者。其中1例在诊断时无胸膜外受累，提示为PPL。在所有病例中，通过内科胸腔镜检查（MT）获取的胸膜活检组织病理学检查对最终确诊至关重要。临床医生应警惕渗出性积液与NHL之间的潜在关系以及MT在B细胞NHL诊断中的作用。
