Secondary involvement of the pleura with lymphoma

Secondary involvement of the pleura with lymphoma (secondary pleural lymphoma) is very common, occurring in ~20% of lymphomas. It may be a result of an extension of lymphoma into the visceral or parietal pleura or be a complicating pleural effusion and is a poor prognostic factor.

Epidemiology

Up to 10% of malignant pleural effusions are due to non-Hodgkin lymphoma .

Clinical presentation

Patients with secondary involvement of the pleural with lymphoma may present with dyspnea (~60%), cough and/or chest pain.

Pathology

Pleural involvement may be unilateral or bilateral and is more common the left .

Any type of lymphoma can be involved by large B-cell type is the most common . In Hodgkin lymphoma impaired lymphatic outflow by mediastinal lymphadenopathy and in non-Hodgkin lymphoma direct pleural infiltration appear to be the underlying cause of pleural disease .

Radiographic features

Pleural effusions are more commonly seen than pleural thickening or pleural masses .

Treatment and prognosis

Presence of pleural effusion in lymphoma is considered a poor prognostic indicator . Systemic chemotherapy, talc pleurodesis and radiation therapy can be considered as treatment options .

Differential diagnosis

See also