Low Grade Primary Pulmonary Lymphoma Presenting as a Lung Abscess: A Case Report

以肺膿瘍表現之原發性低度惡性肺部淋巴瘤

蔡嘉修(Chia-Hsiu Tsai)；涂川洲(Chuan-Chou Tu)；陳拓安(Tau-An Chen)；李祥煒(Xiang-Wei Li)；陳順天(Shun-Tim Chen)

primary pulmonary lymphoma ； mucosa-associated lymphoid tissue lymphoma ； lung abscess

台灣家庭醫學雜誌

23卷1期（2013 / 03 / 01）

47 - 54

英文

一位82歲男性於右肺中葉罹患疑似膿瘍的腫塊。此病灶一開始被誤診為肺膿瘍，因而沒有進行正確治療。超音波指引細針取樣確認為低度惡性肺部淋巴瘤的診斷，經過一系列檢查後支持這是個原發性病灶。接受六個療程的癌德星、阿黴素、長春新鹼、及強體松（CHOP）化療後，患者的症狀明顯改善。胸腔電腦斷層掃描也顯示腫瘤已經縮小。低度惡性原發性肺部淋巴瘤為罕見的惡性腫瘤，大多數的影像學特徵為邊緣不清的混濁區域及空氣支氣管徵象。我們提出案例的表現卻與肺膿瘍的病徵極相似。此個案可以提醒醫師在疑似肺膿瘍的診斷中，若治療無成效時，應考慮病灶為低度惡性原發性肺部淋巴瘤的可能性。

An 82-year-old man developed an abscess-like mass in the middle lobe of his right lung. It was initially misdiagnosed as a lung abscess and, therefore, mistreated. Repeated sono-guided fine needle biopsies confirmed the presence of low-grade primary pulmonary lymphoma, which was supported by the results from serial examinations. Following 6 courses of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), the patient's symptoms showed substantial improvement. A thoracic CT showed that the tumor had been reduced. Most low-grade primary pulmonary lymphoma manifest through an area of opacification with poorly defined margins and air bronchograms. We present the case of this unusual malignancy that mimicked a lung abscess. This case serves to remind clinicians to include low-grade primary pulmonary lymphoma in their differential diagnoses when suspecting lung abscess and when unable to determine positive results from treatment.

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