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Case of Non Hodgkins Lymphoma

INTRODUCTION: Primary pulmonary lymphoma is a distinct entity in which the lymphoma arise de novo in lung tissue. This may include involvement of pulmonary parenchyma and or lymph nodes in the mediastinum.

CLINICAL PRESENTATION: A 67year old female presented with C/O low grade fever, unexplained dry cough,dyspnea on exertion since 1 month.

PAST History:11/2 year before, she was admitted for similar complaints and was found to have anemia & thrombocytopenia, thoroughly investigated. HRCT chest showed multiple parenchymal nodules and insignificant mediastinal adenopathy. Bronchial washings &Trans bronchial lung biopsy were inconclusive. No conclusive diagnosis was made, hence splenectomy was done as per hematologist opinion,considering IDIOPATHIC THROMBOCYTOPENIA. HPE on operated specimen of spleen was normal.
The patient again presented with similar complaints. Repeat HRCT showed multiple endobronchial nodules with mild increase in the size of nodules.

Bronchoscopy showed multiple endobronchial nodules which were biopsied. It was proved to be NHL- Diffuse large cell lymphoma B type, CD20 positive and stain for cytokeratin and endocrine tumors were negative.


Conclusion:Primary NHLis uncommonand should be considered as one of differential diagnosis in a patient with endobronchial nodules and underlying hematological manifestation.