Clinical image
Primary Pleural Lymphoma
Linfoma pleural primario
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No mediastinal or hilar pulmonary lymphadenopathies were found. (B) Medical thoracoscopy: pericentrimetric macular lesions with multifocal distribution and stony consistency. (C) Small to intermedium lymphocytes with nuclear irregularity, admixed with mesothelial cells, H&E 400×. (D) Diffuse expression of CD20 in the neoplastic cells, 400×.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 80-year-old male, smoker, presented with chronic complaints of dyspnoea, anorexia and asthenia. Lung sounds were absent on the lower two-thirds of the right hemithorax.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Chest computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) confirmed the presence of extensive right pleural effusion, without mediastinal or hilar lymphadenopathies.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Thoracentesis revealed an exudative pleural effusion with absence of malignant cells.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Medical thoracoscopy allowed the visualization and biopsy of multifocal parietal pleural based pericentimetric macular lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Histopathological examination revealed small and intermediate cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), with eosinophilic cytoplasm and mild nuclear irregularity with occasional nucleoli, expressing CD20 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D), Bcl2, Bcl6, PAX5 and CD70a, CD10, MUM1 and p53; there was no expression of CD5 and TTF1; MIB-1 proliferative index was 50%. There was also mesothelial cells hyperplasia, with eosinophils.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Neck, abdomen and bone positron emission CT showed no abnormalities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A final diagnosis of primary pleural lymphoma (PPL) was made and chemotherapy was started. PPL is a rare cause of pleural effusion and its endoscopic appearance has seldom been fully characterized (both as multifocal nodular lesions and diffuse unspecified pleural involvement).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> The clinical manifestations are unspecific and large biopsy samples are the key to the diagnosis, allowing for extensive immunohistochemical analysis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 492 "Ancho" => 2167 "Tamanyo" => 235295 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest CT (axial plan (AP)): extensive right pleural effusion conditioning almost complete atelectasis of the middle and lower lobes. No mediastinal or hilar pulmonary lymphadenopathies were found. (B) Medical thoracoscopy: pericentrimetric macular lesions with multifocal distribution and stony consistency. (C) Small to intermedium lymphocytes with nuclear irregularity, admixed with mesothelial cells, H&E 400×. (D) Diffuse expression of CD20 in the neoplastic cells, 400×.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO classification of tumours of the lung, pleura, thymus and heart" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.D. Travis" 1 => "E. Brambilla" 2 => "A.P. Burke" 3 => "A. Marx" 4 => "A.G. Nicholson" 5 => "W.D. 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Xiao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5858/arpa.2012-0294-RS" "Revista" => array:6 [ "tituloSerie" => "Arch Pathol Lab Med" "fecha" => "2013" "volumen" => "137" "paginaInicial" => "1152" "paginaFinal" => "1154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23899073" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rare case of primary pleural lymphoma presenting with pleural effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Sun" 1 => "B. Shang" 2 => "J. Gao" 3 => "S. Jian" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Thoracic Cancer" "fecha" => "2016" "paginaInicial" => "145" "paginaFinal" => "150" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary pleural lymphomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Ahmad" 1 => "J. Pawade" 2 => "S. Falk" 3 => "J.A. Morgan" 4 => "L. Blacumaraswami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "908" "paginaFinal" => "909" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14514950" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022202X15371207" "estado" => "S300" "issn" => "0022202X" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005400000008/v1_201808020445/S0300289617303915/v1_201808020445/en/main.assets" "Apartado" => array:4 [ "identificador" => "45361" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005400000008/v1_201808020445/S0300289617303915/v1_201808020445/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617303915?idApp=UINPBA00003Z" ]
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