Abstract

Background: Pyothorax-associated lymphoma (PAL) is a rare lymphoid malignancy often associated with
artificial pneumothorax for the treatment of pulmonary tuberculosis. Most cases of PAL have
been described by Japanese investigators and only a few cases have been reported in western
literature. Although tuberculosis is a common disease in Pakistani population but to the best of
our knowledge this case is the first to be documented in Pakistan.
Case Report: A 76 years old male patient presented with a history of pain in the left lower chest and dry
persistent cough. Computed tomography (CT) scan showed a pleural based mass in the left para-vertebral gutter. Histopathological examination of the pleural peel revealed extensive fibrosis, necrosis and monotonous sheets of atypical, medium to large sized lymphoid cells. Immunohistochemical examination showed uniform positivity of the lymphoid cells for Leukocyte common antigen (LCA) and CD-20. Epstein Barr virus (EBV) expression by latent membrane
protein 1 (LMP-1) was also confirmed immuno-histochemically. A final diagnosis of pyothorax
associated lymphoma was made.
Conclusions: Pyothorax associated lymphoma is associated with a poor prognosis and a median survival of less than one year. The purpose of reporting this case is that one may come across such cases but with a high index of suspicion immunohistochemistry is the answer to final diagnosis.

Keywords: Lymphoma, Tuberculosis, pyothorax