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Disorders of the Pleura |

Primary Pleural Diffuse B-Cell Lymphoma

Elif Sen, MD; Ugur Gonullu, MD; Koray Ceyhan, MD; Hatice Taslak, MD
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Ankara University School of Medicine Pulmonary Diseases Department, Ankara, Turkey


Chest. 2013;144(4_MeetingAbstracts):503A. doi:10.1378/chest.1703778
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Abstract

SESSION TITLE: Pleural Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary pleural lymphomas are very rare entities. Two types are described in the literature; primary effusion lymphoma, in the setting of human immunodeficiency virus infection, and pyothorax-associated lymphomas, with a strong Epstein-Barr virus association. We present a rare case of primary pleural diffuse B-cell lymphoma.

CASE PRESENTATION: We report a 79-year-old immunocompetent man who presented with progressive dyspnea and nonproductive cough. Chest radiography revealed a right sided pleural effusion and computed tomography showed loculated right pleural effusion. Thoracentesis showed a milky appearance of the pleural fluid. An exudative pleural effusion with very high levels of lactate dehidrogenase and adenosine deaminase (ADA) was detected. Pleural fluid cytology was consistent with diffuse large B-cell lymphoma confirmed by histologic showed atypical large lymphoid cell with prominent nucleoli in pleural effusion. The immunocytochemistry positive cytoplasmic staining for CD 20, negative staining for CD 3, positive nuclear staining for bcl-6, positive cytoplasmic staining for bcl-2, positive nuclear staining for MUM-1, negative staining for HHV-8. Tumor cells had high Ki-67 labelling index ( more than 80 %). In chromogenic in situ hybridization procedure tumor cells are negative for EBER. No other disease site was found in radiologic studies and positron emission tomographic nuclear scanning. He was transferred to our medical oncology department to be administered C-HOP chemotherapy regimen by the diagnosis of primary pleural lymphoma.

DISCUSSION: This unilateral exudative pleural effusion with high level of adenosine deaminase has been diagnosed primary pleural diffuse B-cell lymphoma by extensive cytologic evaluation. Pleural effusion was the only site involved in PET scan. The histologic and immunophenotyping studies revealed a very rare case of primary pleural non-Hodgkin lymphoma.

CONCLUSIONS: We describe this rare case of primary pleural diffuse B-cell lymphoma to discuss about differential diagnosis of exudative pleural effusions with high ADA levels which may be related to a very rare location of primary pleural lymphomas.

Reference #1: Ravikumar G et al. Primary pleural non-Hodgkin lymphoma in a chidl- an exceedingly rare disease. J Pediatric Surgery 2012; 47: E29-E31.

DISCLOSURE: The following authors have nothing to disclose: Elif Sen, Ugur Gonullu, Koray Ceyhan, Hatice Taslak

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