Lung lymphoma

Epidemiology

Diagnosis often needs to be made on transbronchial or needle biopsy. Primary lung lymphoma represents 3.6% of extranodal lymphomas.

Differential diagnosis

• 70-80% are marginal zone B-cell lymphomas of the mucosa-associated lymphoid tissue (MALT) (see extranodal marginal zone lymphoma)³. Lymphoepithelial lesions are present (14/14¹). Co-expression of CD20 and CD43 is common (10/14¹) and help to differentiated from lymphoid hyperplasia. Intra-lymphatic extension may occur (4/14¹). They are also CD5-, CD10- & bcl-2+

• The most common differential is nodular reactive lymphoid hyperplasia. There is a mix of T and B lymphocyte. Lymphoepithelial lesions are common (6/10¹) but the lymphocytes are either CD20+/CD43- or CD3+/CD43+

• Mantle cell lymphoma: positive for CD5, cyclin D1 and IgD but negative for CD10, CD23 and bcl-6.

• Follicular lymphoma: positive for both CD10 and bcl-6 but negative for CD5

• Lymphomatoid granulomatosis

• Primary T-cell lymphoma of the lung is rare⁴. Angiocentric T-cell lymphoma with associated EBV is perhaps the least uncommon T-cell lymphoma of lung⁵.

Prognosis

The prognosis of low grade lymphoma of the lung is good, with 94% survival at five years².

References

¹Begueret, H., Vergier, B., Parrens, M. et al. Primary Lung Small B-Cell Lymphoma versus Lymphoid Hyperplasia: Evaluation of Diagnostic Criteria in 26 Cases. Am J Surg Pathol 2002;26:76-81.

² Cordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest 1993; 103:201-8

³ Fiche M, Caprons F, Berger F, et al. Primary pulmonary non-Hodgkin's lymphomas. Histopathology 1995; 26:529-37

⁴ Li G, Hansmann ML, Zwingers T, et al. Primary lymphomas of the lung: morphological, immunohistochemical and clinical features. Histopathology 1990; 16:519-31

⁵ Sabourin JC, Kanavaros P, Briere J, et al. Epstein-Barr virus (EBV) genomes and EBV-encoded latent membrane protein (LMP) in pulmonary lymphomas occurring in nonimmunocompromised patients. Am J Surg Pathol 1993; 17:995-1002

This page last revised 20.6.2005.

©SMUHT/PW Bishop