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Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis · Journal article
BMC Pulmonary Medicine · September 9, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of a patient with chronic nonproductive cough initially misattributed to lung cancer recurrence on PET-CT imaging, but ultimately diagnosed with diffuse large B-cell lymphoma (DLBCL) by excisional biopsy. The case illustrates the diagnostic challenge of distinguishing second primary malignancies from recurrent disease in post-cancer patients and emphasizes the importance of pathological confirmation rather than relying on imaging alone.
Case report. A woman with history of resected double primary lung cancer presenting with chronic nonproductive cough for over 2 months, elevated mediastinal and right subclavinal lymph nodes on CT, and imaging findings suggestive of recurrence.. Intervention: Lymphoma-directed treatment following biopsy confirmation of DLBCL..
Patient presented with persistent dry cough lasting over 2 months following prior resection of double primary lung cancer PET-CT suggested lung cancer recurrence with metastasis, but EBUS-TBNA biopsy showed no malignant cells Final diagnosis was diffuse large B-cell lymphoma (DLBCL) confirmed by left supraclavicular lymph node excisional biopsy
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Clinicians managing patients with chronic cough and prior cancer history should maintain a broad differential diagnosis and not anchor prematurely on recurrence based on imaging findings alone. Pathological confirmation is essential before initiating cancer-directed therapy, as second primary malignancies including lymphoma can mimic recurrent disease.
A single case report describing diagnostic reasoning and clinical outcome in one patient; illustrative of a diagnostic challenge but insufficient to establish evidence for practice change or clinical efficacy.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians managing patients with chronic cough and prior cancer history should maintain a broad differential diagnosis and not anchor prematurely on recurrence based on imaging findings alone. Pathological confirmation is essential before initiating cancer-directed therapy, as second primary malignancies including lymphoma can mimic recurrent disease.
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Chronic nonproductive cough is a common initial symptom prompting patients to seek medical attention. Its etiology is complex and broad, often posing diagnostic challenges in clinical practice. A woman with a history of resected double primary lung cancer experienced a persistent dry cough for over 2 months. Chest computed tomography (CT) revealed multiple enlarged lymph nodes in the mediastinum and right subclavian region. Pulmonary function tests suggested possible concomitant cough variant asthma. Positron emission tomography-computed tomography (PET-CT) suggested lung cancer recurrence with metastasis. However, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy of the mediastinal lymph nodes showed no malignant cells. Anti-asthma and anti-lung cancer therapies failed to alleviate the dry cough. Ultimately, she was diagnosed with diffuse large B-cell lymphoma (DLBCL) by a left supraclavicular lymph node excisional biopsy. Following lymphoma treatment, her cough resolved and the enlarged lymph nodes regressed. This case highlights that in patients with chronic nonproductive cough post-lung cancer treatment, even when imaging suggests possible recurrence, second primary malignancies (SPMs) such as lymphoma should be considered. Pathological confirmation remains essential.
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