2010 Volume 32 Issue 6 Pages 512-517
Background. Approximately 2% of patients with a greater than 20-year history of chronic pyothorax which developed after artificial pneumothorax for treatment of pulmonary tuberculosis, then develop pleural malignant lymphoma (pyothorax-associated lymphoma, PAL). It has been suggested that chronic inflammatory stimulation transforms normal lymphocytes into lymphoma cells, leading to tumor development in the pyothorax. Case. A 77-year-old man had suffered from artificial pneumothorax of the left lung due to pulmonary tuberculosis from age 18 to 21 years. He visited our hospital because of cough, low grade fever (about 37℃), and an abnormal shadow on chest radiography. Thoracic CT images showed chronic pyothorax with shadows extending from the pyothorax wall to the bronchus in the left lung. Bronchoscopic findings revealed white mucus and yellowish polypoid lesions occluding the orifice of the left superior segmental bronchus, which was diagnosed as diffuse large B-cell lymphoma by a transbronchial biopsy. In situ hybridization showed a nuclear expression of Epstein-Barr virus early ribonucleic acid (EBER) in numerous tumor cells, and PAL was diagnosed. The patient attained complete remission after 6 courses of R-CHOP chemotherapy. Conclusion. We encountered a rare case of PAL with an endobronchial lesion.