Li Sunjie, Huang Yige, Wang Linlin, Zhou Jintao
Suzhou Medical College of Soochow University, Suzhou, 215000, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Taicang Hospital Affiliated With Soochow University, Taicang, 215400, People's Republic of China.
J Med Case Rep. 2025 Jan 31;19(1):42. doi: 10.1186/s13256-024-04973-7.
Primary pulmonary lymphoma is a rare subtype of non-Hodgkin lymphoma. Primary pulmonary diffuse large B cell lymphoma is an exceptionally rare form of primary pulmonary lymphoma. The clinical presentation of primary pulmonary diffuse large B cell lymphoma is often nonspecific, and imaging findings lack pathognomonic features, leading to frequent misdiagnosis and delayed treatment.
An 81-year-old Chinese man presented with a 4-month history of pulmonary nodules and a 2-month history of cough and dyspnea. Initial empiric antibiotic therapy for suspected lung infection was ineffective. A chest computed tomography scan revealed multiple patchy and nodular opacities in both lungs. Bronchoscopy ruled out bacterial and fungal infections, leading to a diagnosis of organizing pneumonia. Treatment with systemic corticosteroids provided transient symptomatic improvement, followed by clinical deterioration. Upon admission to hospital, a percutaneous lung biopsy confirmed the diagnosis of primary pulmonary diffuse large B cell lymphoma. The patient was transferred to the hematology department and received rituximab combined with reduced dose cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy. Despite treatment, the patient's clinical condition deteriorated, leading to eventual mortality owing to disease progression.
Primary pulmonary diffuse large B cell lymphoma is a rare clinical condition with non-specific clinical manifestations, posing significant challenges for accurate and timely diagnosis. Early differentiation from other pulmonary conditions, such as organizing pneumonia, is critical to avoid delayed or inappropriate treatment, potentially improving patient outcomes. This case underscores the importance of a comprehensive diagnostic approach, including histopathological confirmation, in patients with pulmonary lesions that do not respond as expected to empiric therapies on the basis of preliminary diagnoses.
原发性肺淋巴瘤是非霍奇金淋巴瘤的一种罕见亚型。原发性肺弥漫性大B细胞淋巴瘤是原发性肺淋巴瘤中极为罕见的一种形式。原发性肺弥漫性大B细胞淋巴瘤的临床表现通常不具有特异性，影像学表现缺乏特征性，常导致误诊和治疗延误。
一名81岁的中国男性，有4个月的肺结节病史及2个月的咳嗽和呼吸困难病史。最初针对疑似肺部感染进行的经验性抗生素治疗无效。胸部计算机断层扫描显示双肺多发斑片状和结节状阴影。支气管镜检查排除了细菌和真菌感染，诊断为机化性肺炎。全身使用糖皮质激素治疗后症状有短暂改善，但随后病情恶化。入院后，经皮肺活检确诊为原发性肺弥漫性大B细胞淋巴瘤。患者转至血液科，接受利妥昔单抗联合低剂量环磷酰胺、阿霉素、长春新碱和泼尼松龙化疗。尽管进行了治疗，但患者的临床状况仍恶化，最终因疾病进展死亡。
原发性肺弥漫性大B细胞淋巴瘤是一种临床罕见病，临床表现不具有特异性，给准确及时的诊断带来重大挑战。早期与其他肺部疾病如机化性肺炎相鉴别，对于避免治疗延误或不当、改善患者预后至关重要。该病例强调了对于初步诊断后经验性治疗效果未达预期的肺部病变患者，采用包括组织病理学确诊在内的综合诊断方法的重要性。
