CTICasesDiffuse Large B-Cell Lymphoma Presenting as a Primary Lung Mass
Imaging findings
A patient presenting with cough has a well-defined mass on chest radiograph that appears to lie within the left lung, with a visible medial margin arguing against a pleural or mediastinal origin, together with subcarinal fullness. CT confirms subcarinal and left hilar lymphadenopathy and a homogeneous mass containing small areas of low attenuation. The mass has no air bronchograms and no microcavitation, is space-occupying and deflects adjacent vessels, and there is no pleural effusion. The bulky subcarinal adenopathy only barely indents the pulmonary artery.
Key takeaways
Bronchoscopy and nodal biopsy showed a rare presentation of diffuse large B-cell lymphoma as a primary lung mass confined to the chest. The absence of air bronchograms runs against the usual teaching for pulmonary lymphoma: the MALT lymphomas seen with Sjogren syndrome typically appear as soft nodules, whereas this mass looked very solid, and an aggressive lung cancer such as large cell neuroendocrine carcinoma was favored beforehand. Blastomycosis was considered, but the extent of lymphadenopathy was atypical for it. A large volume of lymphoma that displaces rather than compresses adjacent structures is characteristic, since its softness lets it become bulky before symptoms emerge.
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