부산대학교 도서관

A 45 year-old woman was referred to Aichi cancer center hospital in May 1985 for evaluation of coughing of 7 months' duration. The results of physical examination were unremarkable. Liver, spleen and lymph nodes were not palpable. Blood chemistry, hematologic studies and serum protein immunoelectrophoresis were normal. Plain films of the chest showed a poorly defined mass in the lower field of the right lung. Computed tomographic studies revealed the most part of the mass to occupy endobronchial space. At bronchoscopic examination, there was a whitish necrotic mass obstructing the truncus intermedius. Malignant lymphoma was strongly suggested by the biopsy specimens. Since additional studies produced no evidence of either extrathoracic malignancy or systemic lymphoma, she underwent right pneumonectomy and mediastinal lymph node dissection on June 2, 1985. The resected tumor size was 6.3×4.0×4.0cm. It was surrounded by normal lung tissue and no pleural invasion was noted. There was no pleural adhesion, pleural effusion or hilar and mediastinal lymphadenopathy. The tumor was found to mainly involve the endobronchial space and remarkable enlargement of the truncus intermedius and more peripheral bronchi was recognized. Pathologically the tumor was diagnosed as diffuse large cell lymphoma and was considered to have arisen within endobronchial mucosal lymphoid tissue. There was no evidence of lymph node involvement. She remains disease free 15 months after operation.Primary pulmonary lymphomas are uncommon. Pathologically the majority of these lesions consist of “small cell type” lymphoid tumors. On the other hand, “largte cell type” lymphomas constitute only a low percentage of all lesions, and our case belongs to this category. According to the reports in the literature, patients with “small cell type” lymphoma had better 5-year survival rate than those with “large cell type” lymphoma. However, even in cases of “large cell type” lymphomas, when there was no evidence of extrapulmonary invasion or regional lymph node involvement, complete resection of the lesions obtained good prognosis. Therefore, we consider that the treatment of choice for primary pulmonary lymphoma, when limited to the lung only, is surgical resection.