Remedy Publications LLC. Annals of Thoracic Surgery Research 2019 | Volume 1 | Issue 1 | Article 1003 1 Primary Non-Hodgkin Lymphoma of the Pleura Associated with Bilateral Chylothorax: An Unexpected Diagnosis OPEN ACCESS *Correspondence: Bacchin Diana, Department of Surgical, Medical, Molecular, Pathology and Critical Care, Division of Thoracic Surgery, University of Pisa, Via Paradisa 2, Pisa 56124, Italy, E-mail: d.bacchin@hotmail.com Received Date: 27 Apr 2019 Accepted Date: 22 May 2019 Published Date: 31 May 2019 Citation: Bacchin D, Aprile V, Alì G, Palmiero G, Fini D, Carlo Ambrogi M, et al. Primary Non-Hodgkin Lymphoma of the Pleura Associated with Bilateral Chylothorax: An Unexpected Diagnosis. Ann Thorac Surg Res. 2019; 1(1): 1003. Copyright © 2019 Diana Bacchin. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case Report Published: 31 May, 2019 Abstr act Pleural efusion is a common fnding in patients with advanced-stage lymphoma. Primary pleural lymphoma, instead, is a very rare entity that diagnosis is ofen challenging. Tis is a very interesting case of a 65-years-old immunocompetent woman afected by bilateral chylothorax as the only clinical manifestation of primary pleural small-B-lymphocytes non-Hodgkin lymphoma. Te patients underwent to iterative thoracoscopic pleural biopsy since the mediastinal lymph-nodes biopsy and pleural efusion cytological examination were inconclusive. Tis case highlights the importance of a deep investigation of every pleural efusion, also with iterative pleural biopsy, because even an underestimated bilateral chylothorax can hide a rare neoplasm. Keywords: Chylothorax; Pleural lymphoma; Pleural efusion; Non-Hodgkin lymphoma; Talc Introduction Pleural efusion is a common fnding in up to 20% of patients with advanced-stage lymphoma. Primary pleural lymphoma, instead, is a very rare entity, that afects patients sufering from immunodepression, mostly associated with an exudative pleural efusion or pyothorax [1,2]. Diagnosis is ofen challenging, based on clinical presentation (i.e. dyspnea, cough, thoracic pain), radiological fndings (Chest-RX or CT-scan) but also and especially on chemical-physical examination of pleural efusion together with the histological features of the pleural biopsies. Due to its rarity, there are scant data regarding diagnosis, treatment and prognosis of the primary lymphoma of the pleura in literature [3-8]. Tis is a challenging case of a 65-years-old immunocompetent woman who was referred to our Center for bilateral chylothorax. Te diagnosis of primary pleural small-B-lymphocytes non-Hodgkin lymphoma was obtained thanks to iterative thoracoscopic pleural biopsy since the mediastinal lymph-nodes biopsy and pleural efusion cytological examination were inconclusive. Te patient underwent exclusive chemo-immunotherapy without any evidence of recurrence at 5-year follow-up. Background A healthy 65-years-old woman was referred to our Center in August 2013 because of worsening dyspnea and chest pain. She had no history of smoking, professional asbestos exposition or recent thoracic trauma. Te chest X-Ray showed bilateral pleural efusion, greater in the lef hemithorax. Lef thoracoscopy revealed massive pleural efusion with milky-looking fuid and a difuse hyperemia of the parietal pleural without nodules. Cytological and microbiological exams on pleural fuid were negative for presence of bacteria or malignant cells, while its chemical and physical characteristics were suggestive of chylothorax (triglycerides 238 mg/dL, total proteins 2.80 g/dL, specifc weight 1,020). Moreover, pleural biopsies revealed pleural infammation with infltration of a high number of B- and T-lymphocytes, while the mediastinal lymph-node biopsy showed a reactive hyperplasia. In 2 nd post-operative day, a right thoracentesis was performed, with detection of chylothorax Diana Bacchin 1 *, Vittorio Aprile 1 , Greta Alì 2 , Gerardo Palmiero 3 , Donatella Fini 4 , Marcello Carlo Ambrogi 1 and Marco Lucchi 1 1 Department of Surgical, Medical, Molecular, Pathology and Critical Care, Division of Thoracic Surgery, University Hospital of Pisa, Italy 2 Department of Surgical, Medical, Molecular, Pathology and Critical Care, Unit of Pathological Anatomy III, University Hospital of Pisa, Italy 3 Respiratory Unit, Versilia Hospital, Azienda USL 12 Viareggio, Lido di Camaiore, Italy 4 Respiratory Unit, Osp. Civile S. Bartolomeo, Italy