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J Thorac Cardiovasc Surg 2008;136:1472-1475
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Primary chest wall lymphoma with no history of tuberculous pyothorax: Diagnosis and treatment

Abbas Tabatabai, MDa, Mozaffar Hashemi, MDa, Mojtaba Ahmadinejad, MDb, Saeid Haghdanic,*, Mahmoud Sajjadic, Parvin Mahzouni, MDd, Ali Hekmatnia, MDe

a Department of Surgery, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
d Department of Pathology, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
e Department of Radiology, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
b Department of Surgery, Shohada Hospital, Lorestan University of Medical Science, Khorram Abad, Iran
c Medical Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Received for publication January 14, 2008; accepted for publication March 3, 2008.

* Address for reprints: Saeid Haghdani, Poursina Hakim Research Institute, Post Office Box 81588-44771, Isfahan, Iran. (Email: saeed_haghdani{at}yahoo.com).

Objective: Primary chest wall neoplasm represents only 5% of chest wall neoplasm and among them primary chest wall lymphoma is uncommon.

Methods: A 28-year-old man had no history of tuberculous pyothorax or artificial pneumothorax therapy but did have a 4-month history of dyspnea, fever, chills, and night sweats. On physical examination, a mass about 10 x 10 cm was noted on the anterior chest wall on the right side, and computed tomographic scan demonstrated that it originated from the pleural wall. A 42-year-old man was admitted with intermittent left hemithoracic pain from about 6 months before his visit. A 5 x 5-cm tender mass in the posterior wall of the left hemithorax was palpated. Computed tomography showed mild plural effusion and erosion in the posterior segment of the left ninth rib. Surgery was performed for histologic diagnosis.

Results: With the diagnosis of large B cell lymphoma, chemotherapy was prescribed for the first patient, and the patient has been in complete remission for more than 5 months. For the second patient, the left ninth rib along with the originated mass was completely resected and chemotherapy was prescribed. The patient has been in complete remission for more than 8 months.

Conclusion: Treatment of primary chest wall lymphoma was not clear and various treatment strategies were considered. Remission of considerable duration in our patients leads us to suggest that surgery followed by adjuvant chemotherapy can provide a reasonable outcome in patients in whom the chest wall lymphoma is the only site of disease.

Abbreviations and Acronyms CT = computed tomography; PLB = primary lymphoma of the bone






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