Lymphomas involving the pleura: A clinicopathologic study of 34 cases diagnosed by pleural biopsy
Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex 77030, USA. Archives of pathology & laboratory medicine
(Impact Factor: 2.84).
11/2006; 130(10):1497-502. DOI: 10.1043/1543-2165(2006)130[1497:LITPAC]2.0.CO;2
Pleural involvement by lymphoma is relatively common. However, there are very few clinicopathologic studies reported in the literature of lymphomas involving the pleura.
To characterize the clinicopathologic features of lymphomas involving the pleura.
We reviewed the clinicopathologic features of 34 patients with lymphoma involving the pleura proven by biopsy and classified these neoplasms using the World Health Organization classification.
There were 22 men and 12 women, with an average age of 62 years (range, 22-82 years). Nine (26.5%) patients had pleural involvement as the only site of disease, 22 (64.7%) had other sites of involvement, and 3 (8.8%) had inadequate staging data. Eighteen (56.2%) of 32 patients with adequate clinical data had a history of lymphoma (including 3 patients with pleural involvement as the only disease site). In 29 (85.3%) cases, a specific diagnosis according to the World Health Organization classification could be made: 17 (58.6%) diffuse large B-cell lymphoma, 5 (17.2%) follicular lymphoma (including a case with areas of diffuse large B-cell lymphoma), 2 (6.9%) small lymphocytic lymphomas/chronic lymphocytic leukemia, 2 (6.9%) precursor T-cell lymphoblastic lymphoma/leukemia, 1 (3.4%) mantle cell lymphoma, 1 (3.4%) posttransplant lymphoproliferative disorder, and 1 (3.4%) classical Hodgkin lymphoma. The other 5 cases were B-cell lymphomas that could not be further classified. Cytologic examination of pleural fluid was performed in 15 cases and was positive for lymphoma in 8 (53.3%) cases.
Most patients with lymphoma involving the pleura have simultaneous evidence of systemic involvement. The most frequent type is diffuse large B-cell lymphoma, followed by follicular lymphoma. Cytologic examination can have negative results in patients with pleural involvement by lymphoma.
Available from: Mattheos Bobos
- "The vast majority overexpresses Cyclin D1. Vega et al, in their review of 34 patients with lymphoma involving the pleura that was detected by pleural biopsy, found only 1 MCL among the 34 cases . The most frequent type in their series was diffuse large B-cell lymphoma, followed by follicular lymphoma. "
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ABSTRACT: Coexistence of adenocarcinoma and mantle cell lymphoma in the same or different anatomical sites is extremely rare. We present a case of incidental discovery of primary lung adenocarcinoma and mantle cell lymphoma involving the pleura, during an axillary thoracotomy performed for a benign condition.
A 73-year old male underwent bullectomy and apical pleurectomy for persistent pneumothorax. A bulla of the lung apex was resected en bloc with a scar-like lesion of the lung, which was located in proximity with the bulla origin, by a wide wedge resection. Histologic examination of the stripped-off parietal pleura and of the bullectomy specimen revealed the synchronous occurrence of two distinct neoplasms, a lymphoma infiltrating the pleura and a primary, early lung adenocarcinoma. Immunohistochemical and fluorescence in situ hybridization assays were performed. The morphologic, immunophenotypic and genetic findings supported the diagnosis of primary lung adenocarcinoma (papillary subtype) coexisting with a non-Hodgkin, B-cell lineage, mantle cell lymphoma involving both, visceral and parietal pleura and without mediastinal lymph node involvement. The neoplastic lymphoid cells showed the characteristic immunophenotype of mantle cell lymphoma and the translocation t(11;14). The patient received 6 cycles of chemotherapy, while pulmonary function tests precluded further pulmonary parenchyma resection (lobectomy) for his adenocarcinoma. The patient is alive and without clinical and radiological findings of local recurrence or distant relapse from both tumors 14 months later.
This is the first reported case of a rare tumoral combination involving simultaneously lung and pleura, emphasizing at the incidental discovery of the two coexisting neoplasms during a procedure performed for a benign condition. Any tissue specimen resected during operations performed for non-tumoral conditions should be routinely sent for pathologic examination.
Available from: Pradipta Guha
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ABSTRACT: Primary pleural lymphoma is a rare entity that has been described in association with human immunodeficiency virus (HIV) infection
or pyothorax. This paper reports on a 27 year old man with no history of HIV infection or pyothorax who presented with progressive
dyspnea and heaviness of chest. Chest radiography revealed complete opacification of the left hemithorax, and contrast enhanced
computed tomography showed large left pleural effusion and homogeneous, extensive thickening of the parietal pleura. CT guided
biopsy of thickened pleura is suggestive of non-Hodgkin’s lymphoma-T cell lymphoblastic variety. Physicians should be aware
of this rare location of primary pleural lymphoma manifested by thickening of the pleura.
Key Wordsnon-Hodgkin’s lymphoma–T cell–lymphoblastic type–lymphoma–extranodal NK-T-cell
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