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Chest
Diagnosis
Pulmonary Neoplasms
Lymphoma and Lymphoproliferative Disorders
Pulmonary Lymphoma
Pulmonary Lymphoma
Sonia L. Betancourt-Cuellar, MD
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Primary pulmonary lymphoma (PPL)
Non-Hodgkin lymphoma (NHL)
Mucosa-associated lymphoid tissue (MALT) lymphoma
Diffuse large B-cell lymphoma (DLBCL)
Lymphomatoid granulomatosis (LG)
Hodgkin lymphoma (HL)
Secondary pulmonary lymphoma (SPL)
Synonyms
Low-grade primary pulmonary B-cell lymphoma
MALT lymphoma
Definitions
PPL
Pulmonary clonal lymphoid proliferation in patient with no detectable extrapulmonary lymphoma for
at least 3 months after initial diagnosis
Represents 0.5% of primary lung malignancies
Almost all cases of PPL are NHL
~ 70 cases of primary pulmonary HL reported
Represents only 3-4% of cases of primary
extranodal
NHL
Most common subtypes: MALT lymphoma, high-grade DLBCL, LG
MALT lymphoma: Low-grade extranodal B-cell lymphoma, represents majority of cases of PPL
Uncommon subtypes: Pulmonary intravascular lymphoma, primary pulmonary plasmacytoma
SPL
Common as manifestation of systemic involvement by HL and NHL
Lung involvement rate higher in HL (85%) than in NHL (24%), but NHL is far more common and represents up to 90% of all SPL
Mechanisms of lung involvement
Invasion from hilar or mediastinal lymph nodes
Hematogeneous or lymphatic dissemination
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
Nuclear Medicine Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Microscopic Features
CLINICAL ISSUES
Demographics
Mucosa-Associated Lymphoid Tissue
Lymphoma
High-Grade B-Cell Non-Hodgkin Lymphoma
Lymphomatoid Granulomatosis
Primary Pulmonary Plasmacytoma
Pulmonary Intravascular Lymphoma
DIAGNOSTIC CHECKLIST
Consider
Selected References
Angirish B et al: Pulmonary manifestations of lymphoma: A pictorial essay. Lung India. 37(3):263-7, 2020
Cozzi D et al: Primary pulmonary lymphoma: imaging findings in 30 cases. Radiol Med. 124(12):1262-9, 2019
Deng W et al: Pulmonary MALT Lymphoma has variable features on CT. Sci Rep. 9(1):8657, 2019
Yao D et al: Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study. BMC Cancer. 18(1):281, 2018
Bligh MP et al: Spectrum of CT findings in thoracic extranodal non-Hodgkin lymphoma. Radiographics. 37(2):439-61, 2017
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Primary pulmonary lymphoma (PPL)
Non-Hodgkin lymphoma (NHL)
Mucosa-associated lymphoid tissue (MALT) lymphoma
Diffuse large B-cell lymphoma (DLBCL)
Lymphomatoid granulomatosis (LG)
Hodgkin lymphoma (HL)
Secondary pulmonary lymphoma (SPL)
Synonyms
Low-grade primary pulmonary B-cell lymphoma
MALT lymphoma
Definitions
PPL
Pulmonary clonal lymphoid proliferation in patient with no detectable extrapulmonary lymphoma for
at least 3 months after initial diagnosis
Represents 0.5% of primary lung malignancies
Almost all cases of PPL are NHL
~ 70 cases of primary pulmonary HL reported
Represents only 3-4% of cases of primary
extranodal
NHL
Most common subtypes: MALT lymphoma, high-grade DLBCL, LG
MALT lymphoma: Low-grade extranodal B-cell lymphoma, represents majority of cases of PPL
Uncommon subtypes: Pulmonary intravascular lymphoma, primary pulmonary plasmacytoma
SPL
Common as manifestation of systemic involvement by HL and NHL
Lung involvement rate higher in HL (85%) than in NHL (24%), but NHL is far more common and represents up to 90% of all SPL
Mechanisms of lung involvement
Invasion from hilar or mediastinal lymph nodes
Hematogeneous or lymphatic dissemination
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
Nuclear Medicine Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Microscopic Features
CLINICAL ISSUES
Demographics
Mucosa-Associated Lymphoid Tissue
Lymphoma
High-Grade B-Cell Non-Hodgkin Lymphoma
Lymphomatoid Granulomatosis
Primary Pulmonary Plasmacytoma
Pulmonary Intravascular Lymphoma
DIAGNOSTIC CHECKLIST
Consider
Selected References
Angirish B et al: Pulmonary manifestations of lymphoma: A pictorial essay. Lung India. 37(3):263-7, 2020
Cozzi D et al: Primary pulmonary lymphoma: imaging findings in 30 cases. Radiol Med. 124(12):1262-9, 2019
Deng W et al: Pulmonary MALT Lymphoma has variable features on CT. Sci Rep. 9(1):8657, 2019
Yao D et al: Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study. BMC Cancer. 18(1):281, 2018
Bligh MP et al: Spectrum of CT findings in thoracic extranodal non-Hodgkin lymphoma. Radiographics. 37(2):439-61, 2017
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