Pyothorax-associated lymphoma

Last revised by Joshua Yap on 05 Sep 2022

Pyothorax-associated lymphoma (PAL) is a non-Hodgkin lymphoma of exclusively B-cell phenotype that develops in the pleural cavity of patients after a long-standing pyothorax or empyema.

There is a strong association with EBV infection.

Commonly reported locations include 3:

  • lateral costal pleura ~50%
  • costophrenic angle ~30%

Histologically, pyothorax-associated lymphoma usually shows a diffuse proliferation of large B-cells (diffuse large B-cell lymphoma (DLBCL)).

May be seen as a lenticular or crescent-shaped soft tissue mass straddling the thickened pleura at the margin of a coexistent empyema cavity 3. It has a tendency to invade adjacent structures. Air-fluid levels or gas within the empyema cavity may also be present.

It is responsive to chemotherapy, but the overall prognosis is considered poor 1.

In some situations, differential considerations include:

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