Primary pulmonary lymphoma disguised as asthma.

Area of Science:

• Pulmonology and Oncology
• Hematology
• Thoracic Surgery

Background:

• Primary pulmonary lymphoma (PPL) is an extremely rare extra-nodal non-Hodgkin lymphoma (NHL), accounting for less than 1% of all NHL cases.
• PPL predominantly comprises low-grade B-cell lymphomas (58-87%), with high-grade or large B-cell lymphomas being less common (11-19%).
• High-grade PPL typically presents with general and respiratory symptoms, but asthmatic symptoms are infrequently reported.

Observation:

• A 49-year-old woman presented with a four-month history of intractable asthma, characterized by wheezing, dyspnea, and non-productive cough.
• Imaging revealed an irregular, lobulated mass with air bronchograms in the right lower lung lobe.
• The patient's clinical presentation mimicked severe, resistant asthma.

Findings:

• Histopathological examination confirmed the mass as a high-grade B-cell lymphoma.
• The patient experienced complete resolution of all asthmatic symptoms post-operatively.
• Surgical resection of the pulmonary lesion led to a complete remission of her respiratory symptoms.

Implications:

• This case underscores the importance of considering rare pulmonary neoplasms in the differential diagnosis of refractory asthma.
• Prompt diagnosis and surgical intervention for high-grade PPL can lead to favorable outcomes and symptom resolution.
• Highlights the potential for pulmonary lymphomas to present with atypical respiratory symptoms, necessitating a broad diagnostic approach.