Secondary pulmonary lymphoma (SPL) refers to pulmonary involvement with lymphoma when the condition is not limited to the lung and has mediastinal lymph node involvement or evidence of extrathoracic dissemination for at least three months after the initial diagnosis. This is a more common form of pulmonary lymphoma.
The incidence of involvement of the lung at initial presentation is reported to be 12% of patients with Hodgkin’s disease and 4% of those with non-Hodgkin’s hymphoma 1. With non-Hodgkin lymphoma, pulmonary involvement may occur in ~30% (range 25-40%) as a site of relapse after treatment 1,4.
The pathogenesis of secondary pulmonary lymphoma can be rather variable and depends on the type of primary lymphoma 5. While all forms of lymphoma may secondarily involve the lungs, the mature B-cell neoplasms may be the most frequent 5.
On histopathology, secondary pulmonary lymphoma and primary pulmonary lymphoma show identical morphological features 5.
CT - HRCT chest
Radiographic appearances can be variable and can mimic that of primary pulmonary lymphoma 4. It may have a lymphangitic, nodular and/or alveolar pattern.
Individual features are non-specific but reported manifestations include:
- peribronchovascular thickening
- small peribronchovascular nodules
- airspace consolidation with air bronchograms: more common with NHL 5
- large focal masslike lesions
- in Hodgkin disease, parenchymal involvement is almost always associated with mediastinal and/or hilar lymphadenopathy and there is typically a contiguous spread of disease
In some cases a pleural effusion may be present.
- 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
- 1. Lee KS, Kim Y, Primack SL. Imaging of pulmonary lymphomas. AJR Am J Roentgenol. 1997;168 (2): 339-45. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Lewis ER, Caskey CI, Fishman EK. Lymphoma of the lung: CT findings in 31 patients. AJR Am J Roentgenol. 1991;156 (4): 711-4. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Hwang GL, Leung AN, Zinck SE et-al. Recurrent lymphoma of the lung: computed tomography appearance. J Comput Assist Tomogr. 2005;29 (2): 228-30. Pubmed citation
- 4. Raman SP, Pipavath SN, Raghu G et-al. Imaging of thoracic lymphatic diseases. AJR Am J Roentgenol. 2009;193 (6): 1504-13. doi:10.2214/AJR.09.2532 - Pubmed citation
- 5. Hare SS, Souza CA, Bain G et-al. The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol. 2012;85 (1015): 848-64. Br J Radiol (full text) - doi:10.1259/bjr/16420165 - Free text at pubmed - Pubmed citation