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Published on: July 19, 2024
A case of primary pulmonary diffuse large B-cell lymphoma diagnosed by transbronchial biopsy
Naoyuki Yoshino1, Tomomi Hirata, Chie Takeuchi
1Department of Thoracic Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
Insights
A rare case of primary pulmonary diffuse large B-cell lymphoma was diagnosed in a 76-year-old man after detecting an abnormal lung shadow. Surgical resection and follow-up showed no recurrence, confirming successful treatment.
Area of Science:
- Pulmonary Medicine
- Hematology
- Oncology
Background:
- Primary pulmonary lymphoma is a rare extranodal non-Hodgkin lymphoma.
- Early detection and accurate diagnosis are crucial for effective management.
Observation:
- A 76-year-old male presented with an abnormal shadow on chest X-ray.
- CT scan revealed a 20-mm nodule in the right lower lobe.
- Transbronchial biopsy showed atypical cells consistent with lymphoma.
Findings:
- Pathological and immunohistochemical analyses confirmed a diagnosis of diffuse large B-cell lymphoma.
- Surgical resection (right lower lobectomy and mediastinal lymphadenectomy) was performed.
- Post-operative gallium scintigraphy at 5 months showed no signs of recurrence.
Implications:
- This case highlights the importance of thorough investigation for lung nodules.
- Definitive diagnosis and timely surgical intervention can lead to favorable outcomes.
- Primary pulmonary diffuse large B-cell lymphoma is treatable with complete resection.
Abstract:
A 76-year-old man took a chest X-ray for his medical checkup and an abnormal shadow was detected in the right lower lung field. For more detailed examination, he was referred to our hospital. Chest computed tomography showed a 20-mm nodule with relatively regular margins in the right lower lobe. A compact proliferation of circular to polygonal cells with a high nucleus-cytoplasm ratio was evident in a transbronchial lung biopsy. Based on pathological findings, a mature large B-cell lymphoma was diagnosed. Thoracoscopic right lower lobectomy and mediastinal lymphadenectomy were performed. The post-surgical pathological examination showed that the tumor consisted of diffuse to compact proliferation of medium to large atypical lymphocyte-like cells. Immunohistochemical staining yielded positive results for B-cell lineage markers. Five months after surgical resection, neither local recurrence nor accumulation in remote organs was observed on gallium scintigraphy. The diagnosis of primary pulmonary diffuse large B-cell lymphoma was established.
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