[Analysis of lymphoma presenting with pulmonary symptoms: report of 79 cases]

To study the clinical characteristics and diagnostic methods of lymphoma with pulmonary symptoms as the initial manifestations.

Seventy-nine patients with lymphoma presenting with pulmonary symptoms were retrospectively analyzed. These cases were all diagnosed in The First Affiliated Hospital of Guangzhou Medical University during 2007 to 2014. The data were collected, including general features, clinical manifestations, blood examinations, CT scan, diagnostic methods, pathologic diagnosis, misdiagnosis and the reasons.

The median age of the 79 patients was 51 years. Cough (66 cases, 84%), expectoration(55 cases, 70%), weight loss (37 cases, 47%), fever (37 cases, 47%), shortness of breath (34 cases, 43%), enlargement of the peripheral lymph nodes (24 cases, 30%), and rales in both sides of the lungs (20 cases, 25%). Erythrocyte sedimentation rate (ESR), serum lactate dehydrogenase (LDH) and CA125 levels were increased in 51% , 37%, and 49% of the patients respectively. Chest CT scan showed bilateral involvement in 49 cases (62%), unilateral involvement in 23 cases (29%), and mediastinum occupying lesions in 11 cases (14%). The lesions included nodules and masses, infiltration and pulmonary consolidation, diffuse ground-glass shadows or reticular changes, and pleural effusion. Fifty patients had at least 2 kinds of these radiological changes. The pleural effusion of 21 patients were examined, and 20 of them were exudates. Pleural effusion LDH/serum LDH > 3.5, pleural effusion CEA/serum CEA > 1, and pleural effusion CA125 increase were present in 1, 4, and 5 patients respectively. The median value of the pleural effusion LDH and ADA were 224 U/L and 21 U/L. Several methods were used for diagnosis, including transbronchial biopsy(40 cases), peripheral lymph node biopsy (21 cases), percutaneous lung biopsy (8 cases), video-assisted thoracoscopic surgery (3 cases), gastroscopic biopsy (1 case), enteroscopic biopsy (1 cases), pleural mass biopsy (1 case), sternal mass biopsy (1 case), scalp mass biopsy (1 case), mammary glands biopsy (1 case) and pharyngeal biopsy (1 case). The pathological study showed that 8 cases were Hodgkin's lymphoma, and 71 cases were non-Hodgkin's lymphoma. The median misdiagnosis time was 3 months.

The clinical symptoms and radiological features were diverse and nonspecific in patients with lymphoma presented by pulmonary symptoms. Pathological biopsy should be considered early to avoid delay in diagnosis.