Japanese Journal of Clinical Oncology 19:249-257 (1989)
© 1989 Foundation for Promotion of Cancer Research
research-article |
Non-Hodgkin's Lymphoma of the Pleural Cavity Developing from Long-standing Pyothorax. Summary of Clinical and Pathological Findings in Thirty-seven Cases
1Department of Surgery National Kinki Central Hospital for Chest Diseases, Sakai
2Department of Pathology National Kinki Central Hospital for Chest Diseases, Sakai
3Department of Pathology Osaka University Medical School, Osaka
4Division of Epidemiology, Aichi Cancer Center Research Institute Nagoya
5Hematology-Oncology and Clinical Cancer Chemotherapy Division, National Cancer Center Hospital Tokyo
6Pathology Division, National Cancer Center Research Institute Tokyo
7Department of Surgery, National Tokyo Hospital for Chest Diseases Tokyo
8Hematology-Chemotherapy Division, Chiba Cancer Hospital Chiba
9Pathology Department, Tenri Hospital Tenri
10Laboratory of Anatomic Pathology, Kyoto University Hospital Kyoto
*For reprints and all correspondence
Department of Pathology, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634
Received January 31, 1989; accepted June 19, 1989
Our previous study suggested a close relation between a preceding chronic tuberculous pyothorax and the development of non-Hodgkin's lymphoma (NHL) in the pleural cavity. To confirm this further, 37 cases were collected from Japanese hospitals, and their clinical and pathologi cal findings summarized. The age at first admission for lymphoma of patients ranged from 46 to 81 (mean 63) years, the male to female ratio being 5.2:1. All patients were admitted after a 22–55 (mean 33) year history of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis (29 cases) or tuberculous pleuritis (seven cases). The most common presenting symptom was chest pain. The main tumor mass, detected by chest roentgenogram and computed tomographic scans, was situated in the pleura (28 patients), the lung near the pleura (five patients) and the pleura and lung (four patients). The diagnosis of pleural NHL was made by biopsy for 31 of the patients and at autopsy for the other six. Histologically 30 (81%) of the 37 cases were of the diffuse large cell type, and of these the immunoblastic type was the most common (22 cases). Immunological and immunohistologic studies revealed a B-cell nature of the proliferating cells in all but one tumor. Thirty-two patients received chemotherapy and/or radiotherapy. Twenty-seven patients died between one and 144 (median eight) months of diagnosis. Autopsies carried out in 23 cases revealed the disease to have been localized to the thorax in 11 patients. These findings indicated that malignant B-cell lymphoma arose as a monoclonal growth from a pool of proliferating polyclonal B lymphocytes in tissues affected by the chronic tuberculous pyothorax.
Key Words: Pleural lymphoma • B-cell lymphoma • Tuberculosis • Chronic pyothorax
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