Original article
Cardiovascular
Role of Surgery in the Treatment of Primary Pulmonary B-Cell Lymphoma

https://doi.org/10.1016/j.athoracsur.2006.08.026Get rights and content

Background

The purpose of this study was to define the role of surgery in the treatment of primary pulmonary lymphoma (PPL).

Methods

We reviewed all patients presenting with a pathologic diagnosis of PPL in our institution during the past 20 years. We analyzed the outcome and determined the impact of complete versus incomplete surgical resection on survival.

Results

The study included 17 patients with PPL confined to the pulmonary parenchyma. Pathologic diagnosis was low-grade B-cell PPL in 14 patients, high-grade B-cell PPL in 2, and lymphomatoid granulomatosis in 1. A complete resection was performed in 8 patients presenting with low-grade B-cell PPL and in 2 patients with high-grade B-cell PPL. The overall survival of patients presenting with low-grade B-cell PPL was 63% at 10 years; however, survival at 10 year tended to be better when a complete resection was performed (87.5% vs 25%, respectively; p = 0.08). Gender, bilateral disease, or adjuvant therapy did not affect survival. Both patients presenting with high-grade B-cell PPL are alive and free of disease 22 and 36 months after the surgery, respectively. The patient presenting with lymphomatoid granulomatosis is alive after 2 years of follow-up.

Conclusions

PPL is a rare disease that may be localized or diffuse in one or both lungs. Surgery should be the treatment of choice in the localized form of PPL if complete resection can be achieved. A complete resection is associated with an excellent long-term survival of almost 90%. If the lesions are diffuse or involve both lungs, medical therapy should then be the treatment of choice.

Section snippets

Material and Methods

We performed a computer search in our pathology database to identify patients with a biopsy-proven PPL operated on in our institution between 1985 and 2004. For all patients in the study cohort, an individual chart review was performed, with approval obtained from the Institutional Review Board, which waived the need for informed consent.

The diagnosis of PPL was based on characteristic histologic and immunophenotypical features according to the Kiel classification and the WHO classification [2

Results

We identified 17 patients (11 men, 6 women) fulfilling the criteria for PPL, with a median age of 60 years (range, 33 to 71 years). Pathologic diagnosis was low-grade B-cell PPL (MALT lymphoma) in 14 patients (82%; Fig 1) and high-grade B-cell lymphoma in 2 patients (11%; Fig 2). Lymphomatoid granulomatosis was observed in 1 patient. The mean follow-up was 4.3 years (range, 10 weeks to 15 years).

Comment

Primary pulmonary lymphomas are uncommon cancers arising from the lymphoreticular system of the lung and are estimated to occur in approximately 0.5% of all primary lung tumors [9]. They include solitary plasmocytoma, primary Hodgkin disease, and non-Hodgkin lymphoma of the lung. Primary pulmonary non-Hodgkin lymphoma is the most common PPL and is almost always of the B-cell type. B-cell PPL arises from bronchus-associated lymphoid tissue (BALT lymphoma) or from mucosa-associated lymphoid

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