Background: Primary pulmonary lymphoma (PPL) is rare and easily misdiagnosed because of the lack of typical\nclinical features. It most commonly involves elderly patients aged between 60 and 70 years, and pathological\ndiagnosis depends mainly on chest surgery rather than bronchial mucosal biopsy. Via percutaneous needle\naspiration biopsy of the lung of a 33-year-old woman, which had distinct tissue eosinophilia, we diagnosed a rare\ncase of rapidly growing large B cell lymphoma.\nMethods: Bronchial mucosal biopsy and computed tomographyââ?¬â??guided percutaneous needle aspiration biopsy\nwere performed to determine the nature of the lesion, and we identified its immunophenotype using\nimmunohistochemistry. We used BIOMED-2 gene rearrangement PCR to determine lymphocyte clonality; laser\nmicrodissection was used to confirm the clonality of suspicious malignant lymphocytes.\nResults: Morphologically, the lesion was composed of a large number of eosinophilic cells and a few lymphoid\ncells. Immunohistochemical staining revealed a few CD1?-positive cells, but they were S-100ââ?¬â??negative. The small\nlymphoid cells predominantly expressed CD3; the large lymphoid cells expressed CD20 and some scattered large\nlymphoid cells expressed Pax5. However, molecular studies confirmed clonal immunoglobulin heavy chain (IGH)-D\ngene rearrangement in Pax5ââ?¬â??positive large B lymphocytes.\nConclusions: This is the first recorded case of T- cell/histiocyte-rich large B cell lymphoma with tissue eosinophilia\nof the lung. It highlights the unusual morphological features of PPL that might be mistaken for eosinophilic granuloma\nor parasitic infection. In addition, IGH and T cell receptor gene rearrangement play important roles in differentiating rare\nB cell lymphoma from lung spaceââ?¬â??occupying lesions with abundant eosinophils or T cell infiltration.
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