A 69-year-old female presenting with a right hilar mass was diagnosed with primary pulmonary diffuse large B-cell lymphoma via bronchoscopy and treated with R-CHOP immunochemotherapy.
Case Report (n=1)
Primary pulmonary lymphoma is a rare neoplasm that requires a high index of suspicion and multidisciplinary approach for early diagnosis and management.
Abstract Introduction Primary pulmonary lymphoma (PPL) is a rare entity representing less than 1% of primary pulmonary neoplasms. Its clinical presentation is nonspecific; therefore, early diagnosis requires a high index of suspicion, a multidisciplinary approach, and histopathological confirmation. Clinical Case Summary A 69-year-old female patient with a history of hypertension presented with a two-month history of pleuritic right-sided chest pain and dry cough, which progressed to dyspnea and peripheral cyanosis, prompting evaluation in the emergency department. On admission, vital signs and laboratory results were within normal limits. Chest computed tomography revealed a right hilar mass involving the intermediate and lower lobe bronchi, with atelectasis of the posterior segment of the right lower lobe—findings suggestive of a primary or secondary malignant process. Given the suspicion of a pulmonary neoplasm, a flexible bronchoscopy with endobronchial biopsies was performed, revealing an extrinsic, infiltrative, mamillated lesion at the level of the intermediate bronchus. Histopathological examination confirmed diffuse large B-cell lymphoma (DLBCL), germinal center subtype (CD20+, BCL2+, MYC+ 70%, Ki67+ 70%, MUM1+, CD10-, weak BCL6). Positron emission tomography-computed tomography (PET-CT) demonstrated bilateral hypermetabolic hilar masses, para-aortic nodal involvement, and diffuse splenic hypermetabolism, suggestive of advanced disease. Bone marrow biopsy showed hypercellularity with myeloid hyperplasia but no lymphomatous infiltration. The patient remains under hematology follow-up and is receiving disease-specific oncologic therapy. Discussion Primary pulmonary lymphoma (PPL) is an uncommon neoplasm accounting for less than 1% of malignant lung tumors. The most frequent subtype is mucosa-associated lymphoid tissue (MALT) lymphoma, whereas diffuse large B-cell lymphoma (DLBCL) represents an aggressive form associated with poorer prognosis. Its nonspecific clinical and radiologic presentation can mimic bronchogenic carcinoma or infectious diseases, often delaying diagnosis. In this case, bronchoscopy allowed visualization of an infiltrative lesion whose biopsy confirmed germinal center-type DLBCL (CD20+, BCL2+, MYC+, high Ki67 index). PET-CT revealed nodal and splenic involvement. The standard treatment is R-CHOP immunochemotherapy, which offers high response rates and good tolerability, as observed in this patient. This case highlights the importance of including PPL in the differential diagnosis of atypical pulmonary masses and underscores the value of a multidisciplinary approach for early diagnosis and timely management. This abstract is funded by: No
Escalante et al. (Fri,) conducted a case report in Primary pulmonary lymphoma (n=1). R-CHOP immunochemotherapy was evaluated. A 69-year-old female presenting with a right hilar mass was diagnosed with primary pulmonary diffuse large B-cell lymphoma via bronchoscopy and treated with R-CHOP immunochemotherapy.
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