Lymphoma manifested firstly as symptoms in respiratory system: nine cases report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHEN Dan , ZENG Daxiong , CHEN Yanbin , JIANG Junhong ,  HUANG Jian’an

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R.China;

Corresponding author：

HUANG Jian’an, Email: huang_jian_an@163.com

Keywords：

Lymphoma; Symptoms in respiratory system; Lung image; Cancer antigen 125; Lactic acid dehydrogenase

DOI：

10.7507/1671-6205.201606042

Video：

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Objective To explore the clinical characteristics of patients with lymphoma firstly manifested as symptoms in respiratory system. Methods The clinical data of 9 patients with lymphoma were analyzed retrospectively and discussed with literature review. Results There were 7 males and 2 females with an average age of 48.2 years and a median disease course of 20 days. All patients were diagnosed by pathology while specimens were obtained by cervical lymph node biopsies in 2 cases, by CT-guided percutaneous lung biopsies in 2 cases, by bronchoscope mucosal biopsies in 2 cases, by transbronchial needle aspiration biopsies in 1 case, by thoracoscope lung biopsies in 1 case, and by ascites cell block inspection in 1 case. The main symptoms were cough (7/9), expectoration (3/9), fever (3/9) and wheeze (2/9). Chest CT showed tumors (3/9, multiple in 1 case), enlarged mediastinal lymph nodes (6/9), enlarged hilar lymph nodes (3/9), pulmonary consolidation (3/9), pleural effusion (6/9, bilateral in 3 cases), pleural thickening (2/9), pulmonary atelectasis (2/9), patchy shadow (7/9), pericardial effusion (1/9). Laboratory examination demonstrated elevated cancer antigen 125 (CA125) in 7 cases while elevated lactic acid dehydrogenase (LDH) in 4 cases. One patient died during hospitalization in the respiratory department, 1 patient auto-discharged without further treatment, 1 patient died in follow-up period. Five patients remain alive up to now. Conclusions The symptoms of patients with lymphoma are atypical while the chest radiological findings are varied. CA125 and LDH play important role in evaluating disease and predicting prognosis in patients with lymphoma.

Citation： SHEN Dan, ZENG Daxiong, CHEN Yanbin, JIANG Junhong, HUANG Jian’an. Lymphoma manifested firstly as symptoms in respiratory system: nine cases report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(2): 132-136. doi: 10.7507/1671-6205.201606042 Copy

1.	Chan JK, Ng CS, Isaacson PG. Relationship between high-grade lymphoma and low-grade B-cell mucosa-associated lymphoid tissue lymphoma (MALToma) of the stomach. Am J Pathol, 1990, 136(5): 1153–1164.
2.	谭建龙, 刘志光, 邓红英, 等. 以胸腔积液为首发表现的非霍奇金淋巴瘤七例报告并文献复习. 中华血液学杂志, 2016, 37(1): 70–73.
3.	周庆涛, 朱红, 贺蓓. 伴胸部受累的淋巴瘤 25 例临床分析. 中华内科杂志, 2009, 48(10): 846–849.
4.	Alexandrakis MG, Passam FH, Kyriakou DS, et al. Pleural effusions in hematologic malignancies. Chest, 2004, 125(4): 1546–1555.
5.	Chang MH, Kim SJ, Kim K, et al. Clinical features and treatment outcomes of adult B- and T-lymphoblastic lymphoma: results of multicentre analysis in Korea. Leuk Lymphoma, 2009, 50(7): 1119–1125.
6.	杜红文, 付和睦, 张蕴, 等. 胸部恶性淋巴瘤的影像学表现. 中国医学影像技术, 2000, 16(10): 851–853.
7.	柳毅, 胡燕霞, 童国强,等. 11 例原发性肺非霍奇金淋巴瘤患者临床及影像学特点分析. 中华血液学杂志, 2013, 34(12): 1057–1059.
8.	Wislez M, Cadranel J, Antoine M, et al. Lymphoma of pulmonary mucosa-associated lymphoid tissue: CT scan findings and pathological correlations. Euro Respir J, 1999, 14(2): 423–429.
9.	Ferraro P, Trastek VF, Adlakha H, et al. Primary non-Hodgkin's lymphoma of the lung. Ann Thorac Surg, 2000, 69(4): 993–997.
10.	Graham BB, Mathisen DJ, Mark EJ, et al. Primary pulmonary lymphoma. Ann Thorac Surg, 2005, 80(4): 1248–1253.
11.	Cordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest, 1993, 103(1): 201–208.
12.	Factors A. A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med, 1993, 329(14): 987–994.
13.	王晶, 克晓燕, 赵灵芝, 等. 74 例弥漫大 B 细胞淋巴瘤的预后相关因素分析. 中华血液学杂志, 2007, 28(10): 667–670.
14.	Wei G, Yuping ZW, Bing Y, et al. CA125 expression in patients with non-Hodgkin's lymphoma. Leuk Lymphoma, 2006, 47(7): 1322–1326.
15.	隋小璐, 李艳, 高然, 等. 糖类抗原 CA125 在非霍奇金淋巴瘤中的临床诊断意义研究. 中国实用内科杂志, 2009, 29(3): 254–255.
16.	李斌, 刘巍, 卢景琛, 等. 血清 CA125 水平与淋巴瘤细胞浸润及疗效的关系. 肿瘤防治研究, 2008, 35(9): 659–661.

1. Chan JK, Ng CS, Isaacson PG. Relationship between high-grade lymphoma and low-grade B-cell mucosa-associated lymphoid tissue lymphoma (MALToma) of the stomach. Am J Pathol, 1990, 136(5): 1153–1164.
2. 谭建龙, 刘志光, 邓红英, 等. 以胸腔积液为首发表现的非霍奇金淋巴瘤七例报告并文献复习. 中华血液学杂志, 2016, 37(1): 70–73.
3. 周庆涛, 朱红, 贺蓓. 伴胸部受累的淋巴瘤 25 例临床分析. 中华内科杂志, 2009, 48(10): 846–849.
4. Alexandrakis MG, Passam FH, Kyriakou DS, et al. Pleural effusions in hematologic malignancies. Chest, 2004, 125(4): 1546–1555.
5. Chang MH, Kim SJ, Kim K, et al. Clinical features and treatment outcomes of adult B- and T-lymphoblastic lymphoma: results of multicentre analysis in Korea. Leuk Lymphoma, 2009, 50(7): 1119–1125.
6. 杜红文, 付和睦, 张蕴, 等. 胸部恶性淋巴瘤的影像学表现. 中国医学影像技术, 2000, 16(10): 851–853.
7. 柳毅, 胡燕霞, 童国强,等. 11 例原发性肺非霍奇金淋巴瘤患者临床及影像学特点分析. 中华血液学杂志, 2013, 34(12): 1057–1059.
8. Wislez M, Cadranel J, Antoine M, et al. Lymphoma of pulmonary mucosa-associated lymphoid tissue: CT scan findings and pathological correlations. Euro Respir J, 1999, 14(2): 423–429.
9. Ferraro P, Trastek VF, Adlakha H, et al. Primary non-Hodgkin's lymphoma of the lung. Ann Thorac Surg, 2000, 69(4): 993–997.
10. Graham BB, Mathisen DJ, Mark EJ, et al. Primary pulmonary lymphoma. Ann Thorac Surg, 2005, 80(4): 1248–1253.
11. Cordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest, 1993, 103(1): 201–208.
12. Factors A. A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med, 1993, 329(14): 987–994.
13. 王晶, 克晓燕, 赵灵芝, 等. 74 例弥漫大 B 细胞淋巴瘤的预后相关因素分析. 中华血液学杂志, 2007, 28(10): 667–670.
14. Wei G, Yuping ZW, Bing Y, et al. CA125 expression in patients with non-Hodgkin's lymphoma. Leuk Lymphoma, 2006, 47(7): 1322–1326.
15. 隋小璐, 李艳, 高然, 等. 糖类抗原 CA125 在非霍奇金淋巴瘤中的临床诊断意义研究. 中国实用内科杂志, 2009, 29(3): 254–255.
16. 李斌, 刘巍, 卢景琛, 等. 血清 CA125 水平与淋巴瘤细胞浸润及疗效的关系. 肿瘤防治研究, 2008, 35(9): 659–661.

Chinese Journal of Respiratory and Critical Care Medicine

Lymphoma manifested firstly as symptoms in respiratory system: nine cases report and literature review

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