Clinical Study Of Secondary Pulmonary Lymphoma

Objective: The symptoms,signs and imaging findings of secondary pulmonary lymphoma(SPL)were systematically studied,and the methods of differential diagnosis between SPL and lymphoma complicated with pneumonia were explored.Methods: From January 1,2003 to December 1,2019,the clinical data of 16 patients with SPL and 89 patients with lymphoma complicated with pneumonia who were hospitalized in Shanghai Sixth People’s hospital were retrospectively collected.At the same time,a Chinese and English literature search was conducted through online databases.491 SPL cases with clinical or imaging data were selected for the study.The symptoms,signs and radiological findings of 507 patients with SPL were analyzed.Meanwhile,the clinical,laboratory and imaging findings of 89 patients with lymphoma and pneumonia were compared with those of 16 patients with SPL.Results:(1)The respiratory symptoms of SPL included cough,expectoration,dyspnea,chest pain,chest tightness and hemoptysis.The general symptoms included fever,weight loss,fatigue and night sweat.The signs included superficial lymphadenopathy,hepatosplenomegaly,dry/moist rales in the lungs.The CT findings of SPL included multiple/solitary nodule,patchy shadow,mass/masslike consolidation,interstitial thickening and miliary opacity.31.4% of patients had pleural effusion,38.5% of patients had hilar/mediastinal lymphadenopathy.31.8% of the patients showed multiple imaging findings at the same time.The lesions were more common in both lungs,often with multiple lobes involvement,predominantly in the lower lobes.Compared with HL,more NHL patients showed fever,expectoration,dyspnea and weight loss in the symptoms,and nodule/mass type,pneumonic/alveolar type in the imaging.HL patients were more often manifested as cough and superficial lymphadenopathy in the symptoms and signs,and mixed type in the imaging.Hilar/mediastinal lymphadenopathy was more common in HL patients(P<0.05).(2)The proportion of asymptomatic patients in SPL group was higher.Patients with lymphoma and pneumonia were more likely to have cough,expectoration,fever and moist rales in the lungs(P<0.05).The levels of WBC,neutrophil percentage,CRP,PCT and G test in patients with lymphoma and pneumonia were significantly higher than those in patients with SPL(P <0.05).PCT combined with CRP could increase the specificity to 91.3% with the sensitivity of 88.9%.G test combined with CRP could increase the specificity to 100.0% with the sensitivity of 88.9%.In terms of imaging,SPL patients had a wider distribution of lesions,often involving both lungs,more patients with lesions involving ≥3 lobes,air bronchogram and mixed type were more common(P<0.05).Conclusion:(1)The symptoms of SPL were nonspecific and the imaging findings were various.HL patients were different from NHL patients in the symptoms,signs and imaging.(2)When lymphoma patients had lung lesions,SPL should be considered first if the patient was asymptomatic,the WBC,N%,PCT,CRP and G tests were not high,the lung lesions showed both lungs and multilobes distribution,and multiple imaging findings coexisted with air bronchogram.