Yoshida A, Matsumoto H, Iida Y, Takahashi T, Fujita Y, Tuji T, Fujikane T, Shimizu T, Ogasawara H, Saito Y
Division of Respiratory Disease, National Dohoku Hospital, Hokkaido, Japan.
Kekkaku. 1996 Jun;71(6):415-21.
The patient was 69-year-old male. He has a history of treatment for tuberculosis by artificial pneumothorax about 47 years ago. He was admitted an another hospital under the diagnosis of tuberculous pyothorax. He was transferred to our hospital because of chest pain and fever. Laboratory findings on the admission were as follows: ESR was 120 mm/hr, CRP was 20.22 mg/dl and other data were almost within normal limits. Chest X-ray showed a massive shadow in the right lower lung field, adjacent to the chest wall. Computed tomography (CT) showed tumor shadow with low density and invasions into the adjacent chest wall. Histological examination of surgically excised tumor biopsy revealed malignant lymphoma. The patient's condition improved and the size of tumor decreased temporarily by chemotherapy. Then, he began to complain of chest pain and high fever, and tumor in the chest wall invaded into the whole chest wall. He died of disseminated intravascular coagulation despite continuing chemotherapy. Postmortem examination revealed the following findings : the tumor existed mainly in the parietal pleura or the chest wall, adjacent to the lesion of pyothorax, and immunohistochemical examination showed that tumor was malignant lymphoma, diffuse, large B-cell type. Recent studies have shown a close association between EBV infection and pyothorax-associated lymphoma. We have to keep in mind the possible development of malignant lymphoma following tuberculous pyothorax, when we see patients complaining of fever or chest pain with tuberculous pyothorax.
患者为69岁男性。约47年前曾有人工气胸治疗肺结核病史。因结核性脓胸诊断入住另一家医院。因胸痛和发热转至我院。入院时实验室检查结果如下：血沉120mm/hr，C反应蛋白20.22mg/dl，其他数据基本在正常范围内。胸部X线显示右下肺野靠近胸壁处有大片阴影。计算机断层扫描（CT）显示低密度肿瘤阴影并侵犯相邻胸壁。手术切除肿瘤活检的组织学检查显示为恶性淋巴瘤。患者病情经化疗后改善，肿瘤大小暂时缩小。随后，他开始诉说胸痛和高热，胸壁肿瘤侵犯整个胸壁。尽管持续化疗，他仍死于弥散性血管内凝血。尸检结果如下：肿瘤主要存在于壁层胸膜或胸壁，与脓胸病变相邻，免疫组化检查显示肿瘤为恶性淋巴瘤，弥漫大B细胞型。最近的研究表明EB病毒感染与脓胸相关淋巴瘤密切相关。当我们见到有结核性脓胸且诉说发热或胸痛的患者时，必须牢记结核性脓胸后可能发生恶性淋巴瘤。
