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Primary pleural diffuse large B-cell non-Hodgkin's lymphoma diagnosed via [18F]-2-fluoro-deoxy-D-glucose positron emission tomography/computed tomography / F-18 [18F]-2-Fluoro-Deoxy-D-Glucose Positron Emisyon Tomografi/Bilgisayarh Tomografi'de Primer Plevral Diffuz Buyuk B Hucreli Non Hodking's Lenfoma.

Primary pleural lymphoma is a rare entity. We report a 64-year-old-man with primary malignant lymphoma arising in the pleura with no history of persistent pyothorax. Chest computed tomography scan (CT) showed left pleural effusion with thickening of the parietal pleura. There were no intrapulmonary or mediastinal abnormalities. Analysis of pleural effusion did not detect empyema, tuberculosis, mycobacterium species, or mycelium. Initially, malignant mesothelioma was suspected, but it could not be diagnosed by cytological examination of pleural fluid. Flow cytometric analysis of pleural fluid showed cytomor-phologic and immunophenotypic evidence of diffuse B cell Non Hodgkin's Lymphoma (NHL) (Figure 1). [18F]-2-fluoro-deoxy-D-glucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) scan revealed a diffuse F-18 FDG uptake on thickened costal and diaphragmatic parietal pleura in left hemithotax indicating pleural involvement (Figure 2). Pathological and immuno-histochemical (with CEA, LCA, CD20, CD3) examination of the pleural lesion obtained by pleural biopsy revealed that it was B-cell of the diffuse large cell type of NHL arising from the pleura. We have written informed consent and no conflict of interest.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Malignant lymphoma arising in the pleura are rare, comprising 2.4% of the primary chest wall tumors, and most pleural lymphomas develop in association with preceding long-standing pleural disease such as long-standing chronic tuberculous pyothorax or artificial pneumothorax for lung tuberculosis. As a mechanism for pleural lymphoma, it had been suspected that there was chronic stimulation of B-cells in the pleural cavity such as that in long-standing chronic pleural disease, because it was reported that the most common malignant lymphoma arising in the pleura was B-cell non-Hodgkin's lymphoma of the diffuse large cell type histologically (1-7). Human herpesvirus type 8 (HHV8), also known as Kaposi's sarcoma-associated herpesvirus, is a human gamma herpesvirus that underlies the pathogenesis of Kaposi's sarcoma, primary effusion lymphoma and multicentric Castleman's disease. Therefore, Kaposi Sarcoma and Multicentric Castleman's Disease should be considered in the differential diagnosis (8).

Conflict of Interest Statement

The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included.

DOI: 10.5505/tjh.2012.38233

Address for Correspondence: Ilknur AK SIVRIKOZ, M.D., Eskisehir Osmangazi Universitesi, Tip Fakultesi, Nukleer Tip Anabilim Dah, 26480 Eskisehir, Turkey

Phone: +90 222 239 29 79 E-mail: ilknur_ak@yahoo.com

Received/Gelis tarihi: June 11,2010

Accepted/Kabul tarihi: September 7, 2010

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(2.) Iuchi K, Ichimiya A, Akashi A, Mizuta T, Lee YE, Tada H, Mori T, Sawamura K, Lee YS, Furuse K: Non-Hodgkin's lymphoma of the pleural cavity developing from longstanding pyothorax. Cancer 1987; 60: 1771-1775

(3.) Iuchi K, Aozasa K, Yamamoto S, Mori T, Tajima K, Minato K, Mukai K, Komatsu H, Tagaki T, Kobashi: Non-Hodgkin's lymphoma of the pleural cavity developing from longstanding pyothorax: Summary of clinical and pathological findings in thirty-seven cases. Jpn J Clin Oncol 1989; 19: 249-257

(4.) Lui PC, Ng WK, Yam LY, Wong WW, Tai YP: Pyothorax-associated large B-cell lymphoma: case report with emphasis on the potential diagnostic challenge. Hong Kong Med J 2002; 8 (5): 359-362

(5.) Kawahara K, Sasada S, Nagano T, Suzuki H, Kobayashi M, Matsui K, Takata K, Yoshino T, Michida T, Iwasaki T: Pleural MALT lymphoma diagnosed on thoracoscopic resection under local anesthesia using an insulation-tipped diathermic knife. Pathol Int 2008; 58 (4): 253-256

(6.) Kono Y, Funada H, Urata K, Yosimura S, Kotani Y, Satouti M, Negoro S, Takada Y: A case of malignant lymphoma diagnosed by thoracoscopy with local anesthesia. Nihon Kokyuki Gakkai Zasshi 2005; 43 (10): 622-625

(7.) Oikonomou A, Giatromanolaki A, Margaritis D, Froudarakis M, Prassopoulos P: Primary pleural lymphoma: Plaque-like thickening of the pleura. Jpn J Radiol 2010; 28 (1): 62-65

(8.) Ferry JA, Sohani AR, Longtine JA, Schwartz RA, Harris NL: HHV8-positive, EBV-positive Hodgkin lymphoma-like large B-cell lymphoma and HHV8-positive intravascular large B-cell lymphoma. Mod Pathol 2009; 22 (5): 618-626

Ilknur Ak Sivrikoz (1), Zafer Gulbas (2)

(1) Eskisehir Osmangazi University, School of Medicine, Department of Nuclear Medicine, Eskisehir, Turkey

(2) Eskisehir Osmangazi University, School of Medicine, Department of Hematology, Eskisehir, Turkey
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Title Annotation:Images in Hematology
Author:Sivrikoz, Ilknur Ak; Gulbas, Zafer
Publication:Turkish Journal of Hematology
Date:Mar 1, 2012
Words:723
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