Secondary involvement of the pleura with lymphoma
Secondary involvement of the pleura with lymphoma (secondary pleural lymphoma) is very common, occurring in ~20% of lymphomas. It may be a result of an extension of lymphoma into the visceral or parietal pleura or be a complicating pleural effusion and is a poor prognostic factor.
Up to 10% of malignant pleural effusions are due to non-Hodgkin lymphoma 1.
Patients with secondary involvement of the pleural with lymphoma may present with dyspnoea (~60%), cough and/or chest pain.
Pleural involvement may be unilateral or bilateral and is more common the left 2.
Any type of lymphoma can be involved by large B-cell type is the most common 5. In Hodgkin lymphoma impaired lymphatic outflow by mediastinal lymphadenopathy and in non-Hodgkin lymphoma direct pleural infiltration appear to be the underlying cause of pleural disease 3,4.
Treatment and prognosis
Presence of pleural effusion in lymphoma is considered a poor prognostic indicator 2. Systemic chemotherapy, talc pleurodesis and radiation therapy can be considered as treatment options 4.
- primary pleural lymphoma
- differential diagnosis of a pleural effusion
- differential diagnosis of pleural thickening
- 1. Alexandrakis MG, Passam FH, Kyriakou DS et-al. Pleural effusions in hematologic malignancies. Chest. 2004;125 (4): 1546-55. Pubmed citation
- 2. Vega F, Padula A, Valbuena JR et-al. Lymphomas involving the pleura: a clinicopathologic study of 34 cases diagnosed by pleural biopsy. Arch. Pathol. Lab. Med. 2006;130 (10): 1497-502. Pubmed citation
- 3. Das DK. Serous effusions in malignant lymphomas: a review. Diagn. Cytopathol. 2006;34 (5): 335-47. doi:10.1002/dc.20432 - Pubmed citation
- 4. Management of malignant pleural effusions. Am. J. Respir. Crit. Care Med. 2000;162 (5): 1987-2001. doi:10.1164/ajrccm.162.5.ats8-00 - Pubmed citation
- 5. Feller AC, Diebold J, Lennert K. Histopathology of Non-Hodgkin's Lymphomas. Springer. ISBN:3540638016. Read it at Google Books - Find it at Amazon
- overview of lymphoma
WHO classification of tumours of haematopoietic and lymphoid tissues
- Hodgkin lymphoma
mature B-cell lymphoma
- Burkitt lymphoma
- follicular lymphoma
- lymphoplasmacytic lymphoma (Waldenström's macroglobulinaemia)
- lymphomatoid granulomatosis
- mantle cell lymphoma
- mature T-cell and NK-cell lymphoma
- post-transplant lymphoproliferative/lymphoproliferation disorders
- mature B-cell lymphoma
- location-specific lymphomas
- central nervous system
- head and neck lymphoma
- thoracic lymphoma
- gastrointestinal lymphoma
- hepatobiliary lymphoma
- genitourinary lymphoma
- musculoskeletal lymphoma
- cutaneous lymphoma
- lymphoma staging