Clinical analysis of secondary pulmonary diffuse large B-cell lymphoma misdiagnosed as lung cancer

ZHANG Xiang-e; HUANG Song-ping

doi:10.3969/j.issn.1674-3806.2019.01.17

Abstract：Objective To study the clinical characteristics of secondary pulmonary diffuse large B-Cell lymphoma (SPDLBCL) misdiagnosed as lung cancer and the causes of misdiagnosis.Methods The clinical data of 9 SPDLBCL patients who were misdiagnosed as lung cancer in our hospital were retrospectively analyzed.ResultsThere were 5males and 4 females (5∶4), without a history of smoking.6 patients had no previous immune system disease.The main symptoms were cough, expectoration, fever, wheeze, chest pain and hoarse voice and the main signs were superficial lymph node enlargement, decreased breath sounds and rales in the side of the lungs.Laboratory examination demonstrated decreased lymphocyte counts in 6 cases while elevated lactic acid dehydrogenase (LDH) in 8 cases.Chest CT showed tumors in 7cases (multiple in 1 case), patchy shadows in 6 cases, bronchostenosis in 3 cases, pleural effusion in 3 cases, and enlarged mediastinal or hilar lymph nodes in 6 cases.CT scan depicted multiple nodules located in bilateral lungs in 2 cases, enlarged mediastinal or hilar lymph nodes in 1 case.7 cases were formed enhanced CT scans and the lesions showed no enhancement in 1 case, obvious enhancement in 1 case and uneven enhancement in 4 cases.All the cases were diagnosed as SPDLBCL by pathology and immunohistochemistry, among whom 4 cases were diagnosed by lymph node biopsy, 3 patients by CT-guided percutaneous pulmonary biopsy and 2patients by tracheoscopy.Conclusion SPDLBCL is rare clinically and CT can not provide a definitive diagnosis due to nonspecific clinical and CT findings.However, the possibility of SPDLBCL should be highly considered when the mass or nodule with irregular margin and uneven enhancement, surrounding patchy shadows are observed on the chest CT scan.The final diagnoses depend on pathological and immunohistochemical examinations.