Pleural involvement of diffuse large B-cell lymphoma mimicking malignant pleural mesothelioma

Our plain-English summary of Pleural involvement of diffuse large B-cell lymphoma mimicking malignant pleural mesothelioma, by T. Ito, K. Fujita, M. Okamura, et al (Respiratory Medicine Case Reports, 2020).

The study

• Authors: T. Ito, K. Fujita, M. Okamura, Y. Okuno, Z. Saito, O. Kanai, K. Nakatani, K. Moriyoshi, T. Mio
• Journal: Respiratory Medicine Case Reports
• Published: 2020;31:101206
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse large B-cell lymphoma (DLBCL) is a common cancer in haematology. We report a case of DLBCL mimicking malignant pleural mesothelioma (MPM). A 75-year-old man with a 1-week exacerbation of dyspnoea on exertion and right pleural effusion on chest radiography was admitted to our hospital. Positron emission tomography/computed tomography revealed diffuse pleural thick lesions and massive pleural effusion, and these lesions had accumulation of fluorodeoxyglucose. Because we suspected MPM or lung cancer, we performed a biopsy with thoracoscopy to confirm the diagnosis. A biopsy of the pleural effusion with thoracoscopy revealed DLBCL. Chemotherapy was immediately selected, and the diffuse thickened pleural wall and massive pleural effusion of the right chest were significantly improved after two cycles of chemotherapy.

© 2020 The Author(s).

In plain English

This case report from a hospital in Kyoto, Japan, described one 75-year-old man with a lymphoma, diffuse large B-cell lymphoma (DLBCL), whose scans looked like malignant pleural mesothelioma. He had a week of worsening breathlessness on exertion and fluid around the right lung. He had no history of smoking or asbestos exposure. PET-CT scans showed diffuse thickening of the pleura (the lining around the lung), a large pleural effusion, and enlarged lymph nodes in the chest, below the left collarbone (subclavicular) and in the abdomen. Tumor markers were almost normal, and an HIV test was negative. Fluid cytology suggested a blood-cell cancer but was not enough for a diagnosis. A pleural biopsy taken during thoracoscopy showed DLBCL. After two cycles of R-CHOP chemotherapy, the pleural thickening and fluid improved, which the authors described as significant. The authors concluded that clinicians should consider other diagnoses when images look like mesothelioma but the patient's history or laboratory findings are not typical.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 75-year-old man admitted to the authors' hospital (National Hospital Organization Kyoto Medical Center, Kyoto, Japan) with 1 week of worsening breathlessness on exertion and right pleural effusion; dates not given
• Exposure: No asbestos exposure: the patient had no history of smoking or asbestos exposure
• Main results:
  • PET-CT in this patient showed diffuse thick pleural lesions, massive pleural effusion, and enlarged mediastinal, left subclavicular and abdominal lymph nodes, all with fluorodeoxyglucose uptake
  • Tumor markers were almost within normal levels, including soluble interleukin-2 receptor at 455 U/mL, which the authors noted was not elevated
  • An interferon-gamma release assay and an HIV test were negative
  • Cytology of the haemorrhagic pleural fluid suggested a haematological tumor but was inadequate for a precise diagnosis
  • Thoracoscopic pleural biopsy showed DLBCL, and the FDG-avid lesions around the whole pleura were confirmed as DLBCL
  • After two cycles of R-CHOP chemotherapy, the thickened pleural wall and massive right pleural effusion improved (described by the authors as significantly improved)
• The authors' conclusion: The authors concluded that clinicians should keep other diagnoses in mind when images look typical of malignant pleural mesothelioma but the patient lacks typical history or laboratory features, such as a history of asbestos exposure

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Effusion, Lung Cancer, Biopsy, Thoracoscopy, Chemotherapy.

Related studies

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• Plasma cell myeloma presenting with diffuse pleural involvement: a hitherto unreported pattern of a new mesothelioma mimicker — A. Colonna, G. Gualco, et al. (2010)
• Mesothelioma With a Large Prevascular Lymph Node: N1 Involvement or Something Different? — L. Berzenji, P.E. Van Schil, et al. (2018)
• Pericardial mesothelioma mimicking mediastinal lymphoma and systemic rheumatic disease: a case report — G. Hirnle, M. Kapałka, et al. (2024)
• Rapidly progressive sarcomatoid malignant mesothelioma of the pleura mimicking pulmonary empyema — K. Fujita, Y.H. Kim, et al. (2015)
• Diffuse intrapulmonary mesothelioma mimicking pulmonary lepidic adenocarcinoma: a rare case report and review of the literature — W. RanYue, W. ChunYan, et al. (2023)

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