Chest
Volume 103, Issue 1, January 1993, Pages 201-208
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Clinical Investigations
Primary Pulmonary Lymphomas: A Clinical Study of 70 Cases in Nonimmunocompromised Patients

https://doi.org/10.1378/chest.103.1.201Get rights and content

We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.

Section snippets

METHODS

French respiratory physicians were asked to participate in the Clinicopathological Research Group under the auspices of the Société de Pneumologie de Langue Française by referring standardized detailed clinical information, x-ray films, tomograms and computed tomography (CT) scans on nonimmunocompromised patients whose condition they diagnosed between 1970 and 1990 as primary pulmonary non-Hodgkins lymphoma or “pseudolymphoma.” In addition, they were asked to refer cases in which pulmonary

Study Population

Seventy patients were included in the study. Thirty other referred cases were rejected on the basis of the following: histopathologic findings, 13 cases (pathologic diagnosis other than lymphoma in 7, size or quality or both of specimens insufficient for confident diagnosis of lymphoma in 6) and clinical findings, 17 cases (extrathoracic lymphoma present in 7, predominant mediastinal lymphomatous lesions in 5, incomplete clinical information in 5).

Furthermore, six other cases were referred (not

DISCUSSION

The frequency of lymphomas arising in the lung is estimated to be less than 1 percent of all lymphomas.10 The strict inclusion criteria we chose for considering a lymphoma as primary in the lung probably exclude pulmonary localizations of lymphomas of another origin, and this confers a reliable homogeneity to this series.

Eighty-seven percent of our patients had a LG lymphoma and 13 percent had a HG lymphoma. This predominance of LG lymphomas is found in all previously reported series.3, 8, 9, 10

ACKNOWLEDGMENT

We thank T. Greenland for reviewing the translation of this paper and M. C. Thévenet for secretarial assistance throughout the study and preparation of the manuscript. The following clinicians (all from France) also participated in the study on primary pulmonary lymphomas performed by the Clinicopathologic Research Group by contributing one or more patients: J. Y. Bayle (Lyon); J. P. Bernard (Lyon); J. P Bonniot (Chevilly Larue); J. M. Bréchot (Paris); J. Cadranel (Paris); B. Coiffier (Lyon);

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    This work was supported by grant CNEP 90CN43 from Institut National de la Santé et de la Recherche Médicale, Paris, France

    Manuscript received February 4; revision accepted May 28.

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