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[Primary Non-Hodgkin's lymphoma in the chest wall without preceding disease]
S Kitada1, K Komuta, K Takatsugi
1Second Department of Internal Medicine, Osaka Teishin Hospital, Japan.
Insights
This case study highlights a rare instance of Non-Hodgkin's lymphoma presenting as a chest wall mass without prior tuberculous disease. Effective treatment with radiation and chemotherapy led to complete remission in the patient.
Area of Science:
- Oncology
- Hematology
- Diagnostic Imaging
Background:
- Malignant lymphomas of the chest wall typically arise secondary to chronic tuberculous pyothorax or pleuritis.
- This case presents a rare exception, with no preceding history of such conditions.
Observation:
- An 80-year-old male presented with left-sided chest pain and swelling, revealing a chest wall mass on roentgenogram.
- Biopsy confirmed Non-Hodgkin's lymphoma, diffuse mixed-cell type, B-cell lineage.
Findings:
- Initial radiation therapy resulted in significant tumor reduction and complete remission of the chest wall mass.
- A secondary phát triển of Non-Hodgkin's lymphoma occurred in the right femur 22 months later, successfully treated with combination chemotherapy and radiation, achieving complete remission.
Implications:
- Chest wall masses visualized on roentgenograms warrant consideration for malignant lymphoma, even in the absence of predisposing tuberculous conditions.
- This case underscores the importance of considering primary chest wall lymphoma and highlights successful multimodal treatment strategies.
Abstract:
An 80-year-old man was admitted to our hospital with complaints of left-sided chest pain and swelling. A chest roentgenogram revealed a left chest-wall mass. Examination of a biopsy specimen of the mass led to the diagnosis of Non-Hodgkin's lymphoma of diffuse mixed-cell type. Immunohistological examination revealed that it was B-cell type. The chest-wall mass was markedly smaller after radiation therapy, and the patient had a complete remission. About 1 year and 10 months later, Non-Hodgkin's lymphoma developed in the right femur. Combination chemotherapy (cyclophosphamide, adriamycin, vincristine, and prednisolone) and radiation therapy were given. The patient went into a complete remission, and is alive at the time of this writing, 2 years and 6 months after he was first treated. Almost all malignant lymphomas of the chest wall arise in cases of chronic tuberculous pyothorax or tuberculous pleuritis, but in this case there was no preceding disease. When the chest roentgenogram shows a chest-wall mass, we must consider the possibility of malignant lymphoma, even if there is no preceding disease.