ORIGINAL ARTICLES: GENERAL THORACIC
Primary non-Hodgkin’s lymphoma of the lung

Presented at the Poster Session of the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.
https://doi.org/10.1016/S0003-4975(99)01535-0Get rights and content

Abstract

Background. Primary non-Hodgkin’s lymphoma of the lung is a rare entity. Although the prognosis is favorable, clinical features, prognostic factors, and patient management have not been clearly defined.

Methods. We reviewed retrospectively the records of 48 patients operated on for primary pulmonary non-Hodgkin’s lymphoma. The study group consisted of 21 male (44%) and 27 female (56%) patients with a mean age of 61.8 years. Thirty-seven and a half percent of patients were asymptomatic, and 62.5% were seen with pulmonary symptoms, systemic symptoms, or both. A definitive diagnosis was obtained by thoracotomy in 90% of patients, thoracoscopy in 8%, and anterior mediastinotomy in 2%.

Results. Complete surgical resection was possible in 19 patients (40%). A mucosa-associated lymphoid tissue lymphoma (MALT) was found in 35 patients and lymphoma that was not of this type, in 13. The 1-year, 5-year, and 10-year survival rates were 91%, 68%, and 53%, respectively in the group with mucosa-associated lymphoid tissue lymphoma and 85%, 65%, and 64% in the group with lymphoma that was not of the mucosa-associated lymphoid tissue type. None of the prognostic factors studied (mode of presentation, smoking history, bilateral disease, postoperative stage, complete resection, adjuvant chemotherapy, histology) significantly influenced patient survival.

Conclusions. Primary non-Hodgkin’s lymphoma of the lung occurs with nonspecific clinical features. Although patient survival is good, prognostic factors could not be identified.

Section snippets

Material and methods

From 1975 to 1995, 189 patients with a diagnosis of lymphoma underwent a thoracic procedure at the Mayo Clinic. Forty-eight of these patients were found to have primary non-Hodgkin’s lymphoma of the lung. The following were used to identify them: involvement of the lung with non-Hodgkin’s lymphoma; no past history of lymphoma; no evidence of extrathoracic disease at the time of diagnosis including negative results of abdominal computed tomographic scanning and bone marrow biopsy; and no

Results

Complete surgical resection with negative margins was possible in 19 patients (40%). In the remaining 29 patients, the surgical procedure was an incomplete resection (21 patients with bilateral disease, 8 patients with extensive local disease that was unresectable). There were no operative deaths. Complications occurred in 18 patients (37.5%) and included cardiac dysrhythmia in 5, prolonged air leak in 5, hemorrhage requiring reexploration in 3, atelectasis requiring bronchoscopy in 2, and

Comment

The lung is a frequent site of secondary involvement by Hodgkin’s and non-Hodgkin’s lymphoma. However, primary lymphoid tumors of the lung are rare. There is confusion about the definition and classification of these tumors despite the comprehensive review by Saltzstein [7] in 1963. Diseases that have reactive lymphoid proliferations such as pseudolymphoma, lymphoid interstitial pneumonitis, lymphomatoid granulomatosis, and follicular bronchiolitis are morphologically difficult to distinguish

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