Ann Thorac Surg 2005;80:1134
© 2005 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Unusual Chest Lesion: Giant Primary Pulmonary Lymphoma
Nick Dobrilovic, MD,
Creighton B. Wright, MD
*
,
S. Russell Vester, MD,
Manisha A. Patel, MD,
Elizabeth A. Fannin, BA
Department of Surgery, The Jewish Hospital, Cincinnati, Ohio
* Address reprint requests to Dr Wright, Department of Surgery, The Jewish Hospital, Cincinnati, OH45236. (Email: cbw{at}one.net).
A 34-year-old woman was referred for evaluation of a chest roentgenogram abnormality. The patient, a nonsmoker, was immunocompetent with no risk behavior for HIV. She reported a sudden cough that developed, followed by pain in her left anterior chest radiating to the shoulder. The cough was accompanied by subsequent development of bloody mucus. Her symptoms persisted for 1 week with no prior history of similar episodes.
On physical examination, diminished breath sounds were auscultated over the left chest. Chest roentgenogram (Fig 1) demonstrated a large left upper lobe opacification with posterior displacement of the major fissure. Subsequent workup included computed tomographic imaging of the thorax (Fig 2) and a bronchoscopy, which did not provide the diagnosis. Due to the large size of the mass, a tissue biopsy was not pursued because it would not impact the plan for thoracotomy and resection.
The patient underwent a left thoracotomy, revealing a large, solid mass filling the hemithorax from hilum to apex. An intraoperative frozen section evaluation of the specimen suggested lymphoma. A pneumonectomy was performed. Several factors were judged to prohibit completion of a lesser operation (lobectomy and wedge resection). Calcific granulomatous disease involved the hilum and fissure, causing fusion of the two lobes. In addition, the primary lesion was considerable in size and was accompanied by a satellite nodule. In fact, resection of portions of the pericardium and left phrenic nerve were required in conjunction with resection of the specimen. Individual nodes from the inferior pulmonary ligament, aortico-pulmonary window, and paratracheal region were sampled.
Pathologic evaluation of the specimen revealed it to be a large cell malignant lymphoma (B-cell, immunoblastic type), 14 cm in size (Fig 3; hematoxylin & eosin; 40x). A negative bronchial margin was confirmed. Calcification seen on the roentgenogram was found to represent an old histoplasma granuloma within an inferior hilar node. Remaining nodes showed mild lymphadenitis, but no evidence of malignancy. The tumor was determined to be stage IV by the Ann Arbor classification system.
The patient successfully completed eight cycles of "CHOP" (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy and is in complete remission 5 years after the surgery.
 |
Acknowledgments
|
|---|
 Top
 Acknowledgments
|
|---|
Assistance in preparation of this article was provided by Michelle C. Zeiser, AA.
This article has been cited by other articles:
|
|
|
|
 
N. Girard, M. Barbareschi, J.-F. Cordier, and B. Murer
What is a rare tumour and how should it be dealt with clinically?
Pathology of the Lung,
June 30, 2010;
85 - 133.
[Abstract]
[Fulltext]
[PDF]
|
|
|
