Characterization of Artificial Pneumothorax-Unrelated Pyothorax-Associated Lymphoma

Abstract

Pyothorax-associated lymphoma (PAL) is a rare disease developing from a long-term pleural cavity inflammation. Most reported PAL cases have a history of artificial pneumothorax. However, the clinical features of artificial pneumothorax-unrelated PAL remain largely unknown. Here, we reported two PAL cases diagnosed from our center in the past ten years. One case developed from asymptomatic pyothorax after pneumonectomy with a latency of 28 years, while the other case showed a relatively short latency of one year. Then we reviewed the literature of artificial pneumothorax-unrelated PAL by searching PubMed and Google Scholar from 2007. In total, nine artificial pneumothorax-unrelated PAL cases were found, predominantly in old male with median age of 76 years (ranging from 51 to 88). Most cases were diagnosed with diffuse large B-cell lymphoma (DLBCL) (n = 8, 88.9%) and had evidence of Epstein-Barr virus (EBV) infection (n = 6, 66.7%) or tuberculous pleurisy (n = 5, 55.6%). Notably, four cases (44.4%) had short intervals (no more than two years) between pleuritis and PAL. Regarding the overall survival, one-third cases survived more than 5 years after the diagnosis of PAL. In conclusion, the features of artificial pneumothorax-unrelated PAL are comparable with the classic type of PAL, except for some patients with short duration of pleuritis, and need to be identified. Treatment guideline of DLBCL is recommended for the management of PAL.

Figure 1

Imaging assessment of patients with artificial pneumothorax-unrelated pyothorax-associated lymphoma (PAL). Positron Emission tomography/computed tomography (PET/CT) scan in patient 1 (a-b) and contrast-enhanced chest CT  scan in patient 2 (c–e) were performed at the indicated time points.

Figure 2

Immunohistochemical study of biopsy samples from patient 1 (a) and patient 2 (b). H&E: haematoxylin and eosin; PD-L1: programmed death-ligand 1; EBER: Epstein–Barr encoded RNA; and PAX5: paired box gene 5.

Figure 3

A flowchart for the search strategy and report inclusion of artificial pneumothorax-unrelated pyothorax-associated lymphoma case from PubMed and Google Scholar.