Pleural non-Hodgkin's lymphoma developing from long-standing pyothorax: report of a case

A 47-year-old Taiwanese man with a long-standing history of left chronic tuberculous empyema complained of having a painful swelling over the left lower chest wall for a four-month period. Suspecting acute exaggeration of infection, open drainage was performed. Multiple yellow-grayish, fragile substances protruding from the calcified empyema wall were found. Pathologic studies revealed a diffuse large B-cell non-Hodgkin's lymphoma and removal of the tumors en bloc, with the empyema peel and part of the chest wall, was performed two weeks later. The postoperative course was smooth, but the patient refused further chemotherapy. He was well, without local recurrence or metastasis after nine months of follow-up. Malignant lymphoma developing from long-standing pyothorax is very rare, and has been reported only in Japanese series. The relationship between chronic pyothorax and the subsequent development of malignant lymphoma is discussed and the literature is reviewed.