Primary diffuse large B-cell lymphoma as a chest-wall mass: A case report

Abstract

Rationale: Primary diffuse large B-cell lymphoma of the chest wall is extremely rare. A majority of the pleural lymphomas develop in patients with chronic tuberculous pyothorax. The underlying mechanism might be attributed to the sustained stimulation of chronic inflammation. Surgery followed by adjuvant chemotherapy can improve the outcome in some patients with lymphoma localized only in the chest wall. Thus, an early diagnosis of pyothorax-associated lymphoma is essential as it is a malignant, life-threatening condition.

Patient concerns: A 79-year-old male complained of left-side chest pain for more than 2 months, which was not alleviated with nitrates and aspirin. The patient presented an intermittent low fever, anorexia, and marasmus, accompanied by tuberculosis 40 years ago and chronic left-side pyothorax. Also, ANCA (antineutrophil cytoplasmic autoantibody)-associated vasculitis occurred for >3years.

Diagnosis: Computed tomography scan showed a solid mass in the left lateral chest wall. The patient underwent ultrasonic-guided biopsy of the lesion. A diagnosis of primary diffuse large B-cell lymphoma of the chest wall was established after histological examination.

Intervention: Due to advanced age and poor physical condition, the patient received CHOP chemotherapy at a reduced dose.

Outcomes: The patient died 5 days after the first cycle of chemotherapy with severe dyspnea and high fever.

Lessons: The chronic inflammation stimulation might result in the development of lymphoma in the chest wall of patients with long-term pyothorax, vasculitis, or other autoimmune diseases associated with malignancies. The fever, chest pain, or other nonspecific clinical symptoms in these patients should be under intensive focus as it might indicate the development of malignant lymphoma. Thus, histological examination in these patients is essential for accurate early diagnosis.

Figure 1

Computed tomography scan in 2015. The chronic encapsulated pleural effusion with pleural thickening in the left thoracic cavity. No mass was detected in the pleura or chest wall.

Figure 2

Computed tomography scan on May 3, 2018. A solid mass was seen in the left lateral chest wall, involving several ribs. Encapsulated effusion increased more than that in 2015.

Figure 3

Three-dimensional image of ribs’ reconstruction. The abnormality was observed in the bone cortex of the anterior part of the left 5th rib, which indicated the probability of fracture.

Figure 4

Hematoxylin and eosin (H&E) staining of histopathology (×100). The diffused proliferation of lymphoid cells was observed.

Figure 5

Immunohistochemistry of CD20 (3+) (×100). The staining was diffusely positive for CD20.

Figure 6

Immunohistochemistry of Ki-67 (+80%) (×100). The Ki-67 index was 80%.