diffuse large b - cell lymphoma ( dlbcl ) is the most common histological subtype of non - hodgkin 's lymphoma . however , presenting as a primary chest - wall lesion is a rare disease entity . the clinical symptoms are generally non - specific and can lead to a delay in diagnosis . pretherapeutic evaluation usually includes a biopsy for histopathological diagnosis , and radiological imaging for subsequent staging . we demonstrate through a case report how dlbcl was diagnosed in this patient , following investigations for a chronic left - sided pleural effusion . a 67-year - old gentleman was admitted to a district general hospital under a respiratory team for investigations of a chronic left - sided pleural effusion . his past medical history included a myocardial infarction , asbestosis exposure , ex - smoker of 60 pack years , recurrent lower respiratory tract infections , atrial fibrillation , chronic kidney disease and osteoporosis . subsequent high - resolution computed tomography ( ct ) chest demonstrated a well - defined lesion of 7.4 cm  7.6 cm of reduced attenuation in the left lateral chest wall , encasing seventh and eighth ribs , without rib destruction ( fig .  1 ) . figure  1:ct image demonstrating a well - defined chest - wall lesion encasing ribs , without rib destruction . ct image demonstrating a well - defined chest - wall lesion encasing ribs , without rib destruction . two fine needle aspirates ( fna ) failed to yield definitive histology , even though cytology assessment of pleural fluid was in keeping with malignancy ; however , origin could not be identified . the patient , therefore , was referred to the cardiothoracics team and underwent an excisional biopsy of the chest - wall lesion under local anaesthetic as he was not fit for a general anaesthetic . the histopathology results of this biopsy were suggestive of dlbcl , which was positive for cd30 but negative for hodgkin 's and anaplastic lymphomas . epstein - barr encoding region in situ hybridization strongly positive is suggestive of that it could be driven by epstein barr virus ( ebv ) . the patient underwent staging ct of the brain and the abdomen that demonstrated no evidence of metastasis . he was discussed at a regional haematology multidisciplinary meeting , which concluded that , given his comorbidities , it was felt that chemotherapy was not appropriate and the plan was for supportive palliative management . he received regular packed red cell transfusions but died 2 months after his definitive diagnosis . found that only 4 out of 250 patients with lymphoma presented as isolated chest - wall disease . in reports of primary lymphoma of the chest wall most lymphomas do affect the thorax at some stage during the course of the disease ; however , it is reported that < 2% of chest - wall tumours are lymphomas [ 25 ] . dlbcl is an aggressive type of non - hodgkin 's lymphoma that affects the b - cells . it constitutes about 30% of all non - hodgkin 's lymphomas . often , the first presentation is a rapid painless swelling in the neck , axilla or groin , which is caused by enlarged lymph nodes . most dlbcls of the chest wall are frequently reported in the literature to be pyothorax - associated lymphomas . however , his strong smoking and occupational history may have contributed to the disease process . whilst findings of thoracic lymphoma may be evident on plain chest radiography , ct has traditionally been used to evaluate the disease and extent of spread . however , additional modalities such as magnetic resonance imaging ( mri ) and positron emission tomography ( pet)/ct have emerged . pet / ct is more accurate in the overall staging of lymphoma than ct alone and can be used to evaluate treatment response . studies have suggested the importance of surgery in the role of the diagnosis of lymphomas . in this particular case , surgery was important as multiple fine needle aspirations had failed to yield a definitive diagnosis . in one study , the accuracy of diagnosis of lymphomas by fna was exceptionally low . some authors have suggested that patients with primary chest - wall malignancies should receive an excisional biopsy [ 7 , 8 ] . fna is frequently used as a first - line approach , but further procedures are often undertaken for definitive diagnosis and cell typing . chemotherapy is the main treatment for dlbcl , with or without chest - wall involvement . the most common regime is cyclophosphamide , doxorubicin , vincristine and prednisolone ( chop ) . it remains controversial whether patients with lymphoma located only in the chest wall should undergo surgical resection . reported of a patient who underwent surgical resection for a primary chest - wall lymphoma had remained disease free for 4 years . romagurea et al .   reported that surgical debulking is associated with improved survival in stage i  ii diffuse large - cell lymphoma . hsu et al . reported a series of four patients who had isolated chest - wall lymphoma treated with surgical resection and adjuvant chemotherapy .
primary lymphoma presenting as a solitary lesion of the chest wall is extremely rare , as the majority of chest - wall tumours arise from metastasis . 
 we demonstrate a case report of a 67-year - old male who underwent investigations for a chronic left - sided pleural effusion . 
 a computed tomography scan demonstrated a large chest - wall lesion , without rib destruction . 
 he subsequently underwent fine needle aspirations and excisional biopsy for a histological diagnosis .