[A case of malignant lymphoma diagnosed by thoracoscopy with local anesthesia]

Area of Science:

• Oncology
• Pulmonology
• Pathology

Background:

• Pleural effusion in older adults can indicate various conditions, including malignancy.
• Primary pleural lymphomas are rare, often associated with chronic pyothorax.
• Diagnostic challenges exist when initial cytological examination of pleural fluid is inconclusive.

Observation:

• A 67-year-old woman presented with right-sided pleural effusion.
• Chest imaging revealed a thickened pleura and fluid; pleural fluid cytology showed atypical plasma cells.
• Thoracoscopy identified a 5 cm red, soft tumor on the parietal pleura.

Findings:

• Pathological and immunohistochemical analysis confirmed the tumor as marginal zone B-cell lymphoma.
• Cytological examination of pleural effusion alone was insufficient for definitive diagnosis.
• Thoracoscopy under local anesthesia proved safe and effective for diagnosis.

Implications:

• This case highlights the diagnostic utility of thoracoscopy for pleural malignancies when cytology is non-diagnostic.
• The absence of a pyothorax history makes this a rare presentation of primary pleural marginal zone B-cell lymphoma.
• Early and accurate diagnosis is crucial for appropriate management of primary pleural lymphomas.