A 60-year-old woman with no history of tuberculosis, pyothorax or artificial pneumothorax therapy, presented 4 months before her admission an asthenia, fever, chills, and night sweats. Physical examination revealed a mass of 10 cm localised in lateral chest wall (Figure 1). ignificant laboratory findings were as follows: haemoglobin: 9,3g/dL, erythrocyte sedimentation rate: 60 mm/h, LDH rate: 620 UI/ml. Computed tomographic scan confirmed the localisation in chest wall with invasion of the ribs (Figure 2).
A biopsy of the chest tumor was performed and revealed a non-Hodgkin lymphoma with null phenotype. Immunohistochemical staining of the specimen was positive for leukocyte common antigen, CD20, and Ki67 and negative for CD3, vimentin, desmin, chromogranin, neuron specific enolase, CD99, and actin.
The patient received four cycles of chemotherapy CHOP 21 (Cyclophosphamide 750 mg/m2 Intraveinously (IV) at day1, doxorubicin 50 mg/m2 IV at day1, vincristine 1, 4 mg/m2 with a maximum total dose of 2 mg IV at day1 and prednisone 40 mg/m2/day per os from day 1 to 5) followed by local radiotherapy, total dose was 40 Gy delivered as 2Gy daily fractions, 5 day per week. She had a complete response maintained for more than 7 months.
Computed tomography scan of the chest:Soft tissue mass lesion in posterior chest wall with thorax extension accompanied by pleural thickening.