[Clinical analysis of lymphoma with chest involvement: report of 25 cases]

To study clinical characteristics and diagnostic methods of lymphoma with chest involvement.

Twenty-five lymphoma patients with chest involvement were retrospectively analysed, they were all diagnosed in Peking University Third Hospital during 2000 to 2007. The data were collected including clinical manifestations, blood examinations, chest X-ray and CT scan, diagnostic methods and pathologic diagnosis.

The median age of the 25 patients was 46 years old. Pyrexia (13 cases), weight loss over 10 percent in 6 months (11 cases), cough (10 cases), shortness of breath (9 cases) and painless enlargement of the peripheral lymph nodes (16 cases) were common manifestations. Erythrocyte sedimentation rate and serum lactate dehydrogenase (LDH) level were increased in 72.7% and 81% patients, respectively. The enlargement of mediastinum lymph nodes (16 cases, 64%) was the most common presentation of chest radiography, followed by pulmonary involvement (15 cases, 60%) including infiltration or pulmonary consolidation, mass, multiple nodules, diffuse ground-glass shadow, miliary lesion. There were also presentations of pleural effusion (10 cases, 40%), pericardial effusion (4 cases, 16%), chest wall mass (2 cases, 8%). Eighteen patients (72%) had at least two kinds of these presentations. The appearance of pleural effusion were yellow turbid, bloody or chyliform. Rivalta tests were all positive. The median value of pleural effusion examinations were listed as follows: specific gravity 1.031, total cells 9800 x 10(6)/L, WBC 6.72 x 10(9)/L, lymphocyte 86%, neutrophil 14%, protein 31.4 g/L, LDH 296 U/L, adenosine deaminase (ADA) 67.4 U/L. Most patients (16 cases) were diagnosed by surgical biopsy, especially peripheral lymph nodes biopsy (12 cases). Other patients were diagnosed by ultrasound or CT-guided biopsy (5 cases), video-assisted thoracoscopic pleural biopsy (1 case), video-mediastinoscopic mediastinum lesion biopsy (1 case), bronchial mucosa biopsy through bronchoscope (1 case), bone marrow examination (1 case). All the cases were non-Hodgkin lymphoma except one.

There was no specific clinical manifestation for lymphoma with chest involvement, but in almost half of patients there were enlargement of not only peripheral but also mediastinum lymph nodes. And there were some characteristics in serum, pleural effusion, chest X-ray and CT scan. Surgical biopsy of peripheral lymph nodes was a simple and convenient method for diagnosis. Micro-invasive biopsy had good diagnostic value for lymphoma with chest involvement, including ultrasound- or CT-guided biopsy for superficial mass, pleura, lung, liver, spleen and deep lymph nodes, video-assisted thoracoscopic and video-mediastinoscopic biopsy for pleura, lung and mediastinum lesions. But bronchial mucosa and lung biopsy during bronchoscopy had a low diagnostic rate for lymphoma.