Clinical Feature of Primary Pulmonary Non-Hodgkin's Lymphoma

Dong Kyu Oh; Jae Hyung Roh; Jin Woo Song; Dong Soon Kim

doi:10.4046/trd.2010.69.5.354

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Oh, Roh, Song, and Kim: Clinical Feature of Primary Pulmonary Non-Hodgkin's Lymphoma

Original Article

Tuberc Respir Dis 2010;69(5):354-360.

Published online: 19 November 2010

DOI: https://doi.org/10.4046/trd.2010.69.5.354

Clinical Feature of Primary Pulmonary Non-Hodgkin's Lymphoma

Dong Kyu Oh, M.D., Jae Hyung Roh, M.D., Jin Woo Song, M.D., Dong Soon Kim, M.D.

Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address for correspondence: Dong Soon Kim, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Phone: 82-2-3010-3132, Fax: 82-2-3010-6968 E-mail: dskim@amc.seoul.kr

Received 20 July 2010 Accepted 27 September 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Primary non-Hodgkin's lymphoma of the lung is a rare entity. It is represented commonly as marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. Although there have been a few reviews of this lymphoma, clinical features, radiologic findings, management and prognosis have not been well defined.

Methods:

We reviewed the medical records of 24 patients with primary pulmonary lymphoma between January 1995 and September 2008; all diagnoses had been confirmed based on pathology.

Results:

The median follow-up time was 42.3 months (range, 0.1∼131.2 months). Five (20.8%) patients were asymptomatic, 17 (70.8%) patients had pulmonary symptoms, and the remaining 2 (8.3%) patients presented with constitutional symptoms. There were 16 (66.7%) patients with MALT lymphoma, 4 (16.7%) patients with diffuse large B-cell lymphoma and 4 (16.7%) patients with lymphoma that had not received a WHO classification. Radiologic findings of primary pulmonary lymphoma were diverse and multiple nodule or consolidation was the most common finding regardless of pathologic lymphoma type. PET scan was carried out in 13 (54.2%) patients and all lesions showed notable FDG uptake. MALT lymphoma showed a trend of better prognosis (3-year survival, 78.8% vs. 70.0%; 5-year survival, 78.8% vs. 52.5%; p=0.310) than non-MALT lymphoma.

Conclusion:

Primary non-Hodgkin's lymphoma of the lung occurs with nonspecific clinical features and radiologic findings. MALT lymphoma is the most common pathologic type of primary pulmonary lymphoma. This entity of lymphoma appears to have a good prognosis and in this study, there was a trend of better outcome than non-MALT lymphoma.

Keywords: Lung, Lymphoma, Prognosis, Treatment Outcome

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Figure 1.

Clinical courses and final outcomes of the patients with primary pulmonary lymphoma. MALT: mucosa-associated lymphoid tissue; PD: progressive disease; PR: partial response; SD: stable disease; CR: complete remission; Rec.: recurrence; BMT: bone marrow transplantation; RT: radiotherapy; F/U: follow-up.

Figure 2.

Comparison of prognosis using Kaplan-Meier survival curves between patients with MALT lymphoma and non-MALT lymphoma. MALT: mucosa-associated lymphoid tissue.

Table 1.

Characteristics of patients with primary pulmonary lymphoma

Characteristics	No. of patients
Total patients	24
Age, yr	58.2±13.2
Male	13 (54.2)
Ever-smokers	11 (45.8)
Symptoms
Cough	10 (41.7)
Dyspnea	5 (20.8)
Anorexia	1 (4.2)
Chest pain	1 (4.2)
Blood tinged sputum	1 (4.2)
Fever	1 (4.2)
Asymptomatic	5 (20.8)
Biopsy method
VATS	7 (29.2)
Percutaneous needle biopsy	7 (29.2)
TBLB	4 (16.7)
Bronchoscopic mucosal biopsy	6 (25.0)

Data are presented as number, mean±standard deviation, or number (%).

VATS: video-assisted thoracoscopic surgery; TBLB: transbronchial lung biopsy.

Table 2.

Chest CT findings of primary pulmonary lymphoma

CT findings	No. of patients (%)
Multiple nodule or consolidation	14 (58.3)
Single nodule or consolidation	4 (16.7)
Bronchiectasis and bronchiolitis	3 (12.5)
Diffuse interstitial lung disease	2 (8.3)
Normal	1 (4.2)

Table 3.

Pathologic diagnosis of primary pulmonary lymphoma

Pathologic diagnosis	No. of patients (%)
MALT lymphoma	16 (66.7)
Diffuse large B-cell lymphoma	4 (16.7)
Others^∗	4 (16.7)

MALT: mucosa-associated lymphoid tissue.

^∗ Others include B cell lymphoma with large cell type, NK cell lymphoma, B cell lymphoma and malignant lymphoma with diffuse large cell type.

Table 4.

Comparison of CT findings according to pathologic diagnosis

	MALT lymphoma	Diffuse large B-cell lymphoma	Others^∗
Multiple nodule or consolidation	10 (62.5)	1 (25)	3 (75)
Single nodule or consolidation	3 (18.8)	0	1 (25)
Bronchiectasis and bronchiolitis	2 (12.5)	1 (25)	0
Diffuse interstitial lung disease	1 (6.3)	1 (25)	0
Normal	0	1 (25)	0
Total	16 (100)	4 (100)	4 (100)

Data are presented as number (%).

MALT: mucosa-associated lymphoid tissue.

^∗ Others include B cell lymphoma with large cell type, NK cell lymphoma, B cell lymphoma and malignant lymphoma with diffuse large cell type.

Table 5.

Comparison of standard uptake value measured by 18F-FDG PET between MALT and non-MALT lymphoma

Biopsy finding	SUV	p-value
MALT lymphoma	3.6±2.5	0.334
Non-MALT lymphoma^∗	8.5±6.2

Values are presented as mean±standard deviation.

MALT: mucosa-associated lymphoid tissue.

^∗ Non-MALT lymphoma include diffuse large B cell lymphoma, B cell lymphoma with large cell type, NK cell lymphoma, B cell lymphoma and malignant lymphoma with diffuse large cell type.

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