Korean J Radiol.  2015 Feb;16(1):213-216. 10.3348/kjr.2015.16.1.213.

The Pleural Sandwich Sign in Two Cases of Primary Pleural Lymphoma

• Kim Y
• Lee M
• Ryu YJ
• Cho MS

• KMID: 2070003
• DOI: http://doi.org/10.3348/kjr.2015.16.1.213

Abstract

The sandwich sign is used to describe mesenteric lymphoma in which mesenteric vessels and fat are enveloped by enlarged mesenteric lymph nodes. We present two cases of primary pleural lymphoma demonstrating the "pleural sandwich sign". Contrast-enhanced computed tomography showed conglomerated parietal pleural and extrapleural masses encasing the intercostal arteries. Histopathological examinations confirmed low grade marginal zone B-cell lymphoma in an 80-year-old man and diffuse large B-cell lymphoma in a 68-year-old man. The pleural sandwich sign may suggest the diagnosis of primary pleural lymphoma.

Keyword

Lymphoma; Pleura; Computed tomography; Needle biopsy

MeSH Terms

Aged
Aged, 80 and over
Antigens, CD20/metabolism
Antineoplastic Agents/therapeutic use
Humans
Lymphoma, B-Cell, Marginal Zone/*diagnosis/drug therapy/metabolism
Lymphoma, Large B-Cell, Diffuse/*diagnosis
Male
Pleura/*pathology
Pleural Neoplasms/*diagnosis/drug therapy/metabolism/pathology
Positron-Emission Tomography
Tomography, X-Ray Computed
Antigens, CD20
Antineoplastic Agents

Figure

• 

  Fig. 1 80-year-old man with primary pleural lymphoma (marginal zone B-cell lymphoma). A. Contrast-enhanced CT showing pleural effusion and diffuse homogeneous pleural mass invading into extrapleural space in right hemithorax. Intercostal artery is enveloped by parietal pleural and extrapleural masses, demonstrating sandwich sign (arrows). B. F-18-fluorodeoxyglucose positron emission tomography showing diffuse hypermetabolism in right pleural mass. C. Pleural biopsy revealing diffuse infiltration of small to medium-sized lymphoid cells with scant to moderate amount of clear cytoplasm which is consistent with marginal zone B-cell lymphoma (hematoxylin and eosin stain, 400 × magnification).

• 

  Fig. 2 Sandwich sign in 68-year-old man with primary pleural lymphoma (diffuse large B-cell lymphoma). A. Axial image of contrast-enhanced CT showing right pleural effusion and diffuse pleural mass extending into extrapleural space and paraspinal region. Sandwiching of intercostal artery by conglomerated pleural and extrapleural masses is noted by arrows. B. Pleural fluid cell block specimen showing numerous large atypical lymphoid cells (hematoxylin and eosin stain, × 400 magnification).

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