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. 2014 Jan;5(1):78-81.
doi: 10.1111/1759-7714.12027. Epub 2014 Jan 2.

Primary anaplastic large cell lymphoma of the lung presenting with acute atelectasis

Sang Hoon Han  1 , Young Hee Maeng  2 , Young Sill Kim  2 , Jae Min Jo  1 , Jung Mi Kwon  1 , Woo Kun Kim  1 , Mi Ok Kim  1
Affiliations

Primary anaplastic large cell lymphoma of the lung presenting with acute atelectasis

Sang Hoon Han et al. Thorac Cancer. 2014 Jan.

Abstract

Non-Hodgkin lymphoma only rarely occurs as a primary lung mass. We report a very rare case of primary pulmonary anaplastic large cell lymphoma presenting with acute atelectasis in a 55-year-old man. Chest computed tomography revealed a consolidated central mass in the left lung with obstructive pneumonia that had developed into total atelectasis. After a bronchoscopic examination failed to yield a definite diagnosis, supraclavicular lymph node biopsy was performed, revealing an anaplastic large cell lymphoma. This case illustrates the need for rapidly locating a possible biopsy site, other than the primary lung mass itself, and the value of empirical steroid treatment for avoiding devastating exacerbation when aggressive pulmonary lymphoma is suspected.

Keywords: Lung; lymphoma; pulmonary atelectasis.

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Figures

Figure 1
Figure 1
An initial chest computed tomography (CT) scan reveals a consolidated central mass in the left lung with surrounding ground-glass attenuation. Multiple enlarged lymph nodes are also present in the left supraclavicular area and the mediastinum, suggesting lung cancer with multiple lymph node metastases causing obstructive pneumonia.
Figure 2
Figure 2
After exacerbation, a chest radiography film reveals total atelectasis of the left lung (left). Positron emission tomography (PET) revealed a huge malignant mass accompanied by pleural seeding in left thorax and multiple metastatic lymph nodes with intense fludeoxyglucose (FDG) uptake (right).
Figure 3
Figure 3
Photomicrographs show total effacement of nodular architecture (a. hematoxylin and eosin [H&E] staining, ×10) and diffuse infiltration of large anaplastic cells with frequent mitosis (b. H&E staining, ×400). The tumor cells were positive for CD30 (c. immunohistochemistry, ×400) and destructing the lung parenchyme (d. H&E staining, ×40).
Figure 4
Figure 4
A chest radiography film taken on day 13 of the first cycle of chemotherapy shows that atelectasis of left lung was almost resolved.
See this image and copyright information in PMC

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