Pulmonary relapse of non-Hodgkin's lymphoma in bilateral upper lobes.

We describe a 68-year-old male patient with diffuse large B-cell lymphoma (DLBCL) who suffered from relapse in bilateral upper lobes of the lung. The patient presented with cough, weakness and fever. A bronchovascular-lymphangitis-like shadow was detected in the bilateral upper lobes on a chest roentgenogram. Although cytological and cytofluorometric examinations revealed no malignant cells in the bronchoalveolar lavage fluid, trans-bronchial lung biopsy (TBLB) showed involvement of DLBCL in the bronchial mucosa. Recurrent lymphoma tends to extend along the bronchovascular bundles, resulting in granulomatous consolidation that may mimic tuberculosis and is likely to involve the lower lobes. Thus, TBLB proved to be essential for the diagnosis of the lung involvement of non-Hodgkin's lymphoma (NHL).