The Surgical Treatment of Primary Malignant Lymphoma of the Lung

¹ Fellow in Surgery, Mayo Foundation
² Section of Surgery, Mayo Clinic and Mayo Foundation
³ Section of Surgical Pathology, Mayo Clinic and Mayo Foundation

The clinical and pathologic features of ten patients treated surgically for primary pulmonary lymphoma and a follow-up comparative study of nine cases previously reported are presented.

The most common symptoms were cough and fever of variable duration, although about 25 per cent of the patients were asymptomatic. No roentgenographic manifestations could be considered typical of this disease, although in 16 of the 19 patients thoracic roentgenograms suggested a neoplastic process. Cavitation was seen in six of the entire group including two thirds of the patients with Hodgkin's disease.

Significant bronchoscopic findings were noted in ten of the 19 cases, and in four, biopsy was positive.

Pulmonary, hilar and mediastinal involvement was usually more extensive in Hodgkin's disease and reticulum cell sarcoma than in malignant lymphoma of the lymphocytic or lymphoblastic type, although the duration of symptoms before the patient consulted a physician was longer in the last group.

Nine of 19 patients are still living, seven without clinical or roentgenologic evidence of lymphoma; two of these seven have survived five or more years.

The present study indicates that primary pulmonary malignant lymphomas of the lymphocytic type behave more favorably than Hodgkin's granuloma or reticulum cell sarcoma. The treatment suggested for primary pulmonary lymphoma is surgical excision which may be supplemented by irradiation therapy if the intrathoracic disease is extensive.