There are very few clinicopathologic studies in the literature of lymphomas involving the pleura; diagnosis was usually made by needle core biopsy,excisional biopsy,thoracoscopic decortication,VATS biopsy.We found only 2 case reports with diagnosis made by medical thoracoscopy.To characterize the thoracoscopic features of lymphomas involving the pleura.
We reviewed the 381 medical thoracoscpy from 2002 to 2008 and found 3 lymphomas involving the pleura proven by pleural biopsy during medical thoracoscopy.
Case1:81 year-old woman with right pleural effusion and right superior mediastinal lymphadenopathy.MT:parietal pleura with smooth orange nodules(size3–5 mm);grade 1 follicular lymphomas;Case2:20 year-old man with left pleural effusion.MT: multiple pink confluent nodules ( > 10 mm)on parietal pleura:T-cell lymphoblastic lymphoma.case 3: 70 year-old woman with bilateral pleural effusion and mediastinal lymphoadenopathy. Left MT:parietal pleura with diffuse white thickening and micronodules ( < 1mm); small B lymphocytic lymphomas.No patients had evidence of HIV infection.In all cases cytologic examination of pleural fluid was negative.
Primary pleural lymphomas is extremely rare.By contrast,pleural involvement by sistemic lymphomas is relatively common. Approximately 16% of patients with LNH present, or subsequently develop, pleural involvement during the course of disease. When large specimens are needed for histological diagnosis blind needle biopsy is unlikely to yield satisfactory results and medical thoracoscpy is the preferred choice. Lymphoma involving the pleura could be diagnosed by medical thoracoscopy biopsy; macroscopic pattern is varied. Cytologic examination can have negative results in patient with involvement by lymphoma.
Mesotheliomas and lymphomas are the most problematic in yielding positive results by cytology while medical thoracoscopy is very good in those cases.Medical thoracoscpy is safe and useful for diagnosis of pleural lymphoma.
Massimiliano Sivori, No Financial Disclosure Information; No Product/Research Disclosure Information