Pyothorax-Associated Lymphoma: A Case Report

Pyothorax-associated lymphoma (PAL) is a disease entity that occurs in patients who have undergone therapeutic artificial pneumothorax or treatments for pulmonary tuberculosis (TB). PAL was first recognized in Japan, and large series of reports were published by Japanese clinicians. Sporadic cases have been reported in Western countries and in Asian countries other than Japan. We are not aware of any PAL case that has been reported in Taiwan, where pulmonary TB is still a major public problem, particularly among Taiwanese aboriginal peoples that live in the mountains. We report a patient with a history of old pulmonary TB presenting with progressive right lower back pain. The chest radiography and computerized tomography revealed right-sided pleural effusion with a hypo-dense lesion with formation of a localized abscess in the postero-lateral aspect of the right pleural cavity. The pleural lesion had destroyed the 11th rib and invaded the chest wall. Under the impression of right pleural tumor with pyothorax, the patient underwent limited right thoracotomy with decortication and resection of the destroyed rib. The pathologic study turned out to be large B cell lymphoma with invasion of the rib. This final diagnosis was confirmed immunohistochemically and the clinicopathologic diagnosis of PAL was established on the basis of lymphoma in conjunction with pyothorax. To the best of our knowledge, this is the first report of a case of PAL in Taiwan, and it is our belief that other PAL cases have been unrecognized by the medical community. We anticipate that more cases of PAL will be reported in the future when clinicians become aware of this disease entity and become alert to the possibility of a diagnosis of PAL whenever they come across a patient with back pain, a mass in the chest wall, and ongoing chronic inflammation in the pleural cavity.