Pulmonary non-Hodgkin Lymphoma Research Articles

Primary pulmonary non-Hodgkin lymphoma of T cell: case report

患者男,33岁.于1个月前开始不明原因发热,体温最高达39℃;伴少量咳嗽,痰少量、呈白色偶带黄色,痰中无血丝.当地医院CT检查:两肺有多发结节影,拟诊为韦格肉芽肿,予抗感染治疗,为求进一步诊治来我院.体检:体温37.1℃;脉搏92 次/min;呼吸22 次/min;血压134/83 mm Hg(1 mm Hg=0.133 kPa);神志清,全身浅表未触及肿大淋巴结,胸骨无压痛,两肺未闻及干、湿性啰音。

CT scan findings of primary pulmonary non-Hodgkin's lymphoma and their relation to pathological features

To investigate the CT scan findings of primary pulmonary non-Hodgkin's lymphoma (PPNHL) and their relation to pathological features. The CT scan findings of 17 PPNHL cases confirmed pathologically from August 1992 to June 2007 were analyzed in relation to their pathological foundation. In 17 cases the CT findings showed: 1) Five were single mass or nodule, including 3 with air-bronchograms, 1 with straddling-lobe distribution and 3 with slight enhancement; 2) One was multi-nodules with air-bronchograms; 3) Six were consolidation with air bronchogram,including 3 with straddling-lobe distribution and 3 with slight enhancement; 4) Five were combined changes, including 5 with air-bronchograms, 2 with straddling-lobe distribution and 4 with slight enhancement. The CT features of PPNHL corresponded to their pathological process and pathological features. Primary pulmonary non-Hodgkin's lymphoma should be considered when CT scan shows variety of images found in one patient, middle lobe of right lung involved, air-bronchograms and straddling-lobe distribution in consolidation with slight enhancement.

Primary pulmonary mucosa-associated lymphoid tissue lymphoma computed tomography findings: a case report

Primary pulmonary non-Hodgkin's lymphoma is a very rare neoplasm. It is most frequently represented by the mucosa-associated lymphoid tissue type. We describe a case of a 67-year-old woman who presented with fatigue, mild dyspnea, and consolidation on chest radiograph. The diagnosis of non-Hodgkin's lymphoma was established by transbronchial biopsy, and chemotherapy was then started. The patient was treated with 6 cycles of chemotherapy. She had good response to therapy and no progression of the disease was observed during a 4-year follow-up period. The clinical, radiological and histopathological features are described. This entity has an indolent course, good response to therapy and favorable prognosis. However, despite being an incidental radiological finding in a third of cases, this disease remains highly underdiagnosed.

The changing spectrum of pulmonary disease in patients with HIV infection on antiretroviral therapy

The pulmonary manifestations of HIV disease in 2005 can be divided into two sets of presentations. For patients who do not have access to care, and who are not taking antiretroviral or chemoprophylactic drugs, opportunistic infections and neoplasms continue to occur. Pulmonary disease caused by Streptococcus pneumoniae, Pneumocystis carinii (now known as Pneumocystis jiroveci pneumonia; PCP), Mycobacterium tuberculosis, lymphoma, and Kaposi’s sarcoma present much as they did in the 1980s. Management has improved in terms of new diagnostic, therapeutic, and preventive strategies, as reviewed in guidelines issued jointly by the National Institutes of Health, Centers for Disease Control and Prevention, and Infectious Disease Society of America (available online at http://www.aidsinfo.nih.gov).

Changes in the Pattern of Respiratory Diseases Necessitating Hospitalization of HIV-infectedPatients Since the Advent of Highly Active Antiretroviral Therapy

The incidence rates of opportunistic diseases, hospital admission and death have fallen markedly since the advent of highly active antiretroviral therapy (HAART). We examined the impact of HAART on the pattern of HIV-related respiratory diseases necessitating hospitalization. We retrospectively compared the numbers and etiologies of respiratory diseases diagnosed in HIV-infected patients hospitalized in the chest department of a Paris university hospital during the three years preceding widespread prescription of HAART in France (era 1, starting in July 1993) and the first three years of widespread HAART prescription (era 2, starting in July 1996). Respectively, 207 and 119 HIV-infected patients were admitted for respiratory disease in era 1 and era 2. Only 31.1% of patients admitted during era 2 were receiving HAART. Pulmonary opportunistic infections other than Pneumocystis carinii pneumonia (PCP) (p = 0.0008) and exacerbations of chronic bronchial disease due to gram-negative bacilli (p = 0.04) virtually disappeared in era 2. In contrast, PCP, bacterial pneumonia, tuberculosis, pulmonary Kaposi's sarcoma and pulmonary non-Hodgkin lymphoma showed only a twofold decrease in era 2, while lung cancer was more frequent (p = 0.004). The frequency of severe respiratory diseases necessitating hospitalization of HIV-infected patients has fallen since the advent of HAART, and their etiologic distribution has changed.

Primary pulmonary non-Hodgkin's lymphoma.

Primary pulmonary non-Hodgkin's lymphoma is a very rare neoplasm. It is represented most commonly by marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. Although there have been a few reviews of this lymphoma, clinical features, diagnostic procedure, optimal management and prognostic factors have not been well defined. We reviewed the medical records of 24 patients who were pathologically and clinically diagnosed as primary pulmonary lymphoma between September 1995 and June 2003. There were 13 patients with MALT lymphoma and two with MALT lymphoma accompanied by large B-cell lymphoma, seven with diffuse large B-cell lymphoma and two with anaplastic large cell lymphoma. Half the patients were asymptomatic at presentation; 46% had respiratory symptoms and 16.7% had B-symptoms. Initial radiological findings were variable including nodules, masses, infiltrates or consolidation. The majority of patients (66.7%) needed surgical approaches (open thoracotomy or video-assisted thoracoscopy) for definite diagnosis. Bronchoscopy was performed in 83%, but only 30% showed a diagnostic yield. The 13 patients with MALT lymphoma were treated with a variety of modalities such as observation, surgery and single or combination chemotherapy, and combination chemotherapy was administered to 11 patients with non-MALT lymphoma regardless of surgery. The overall survival rate at 3 years for all 24 patients was 86% with a median follow-up of 32 months. Although this entity of lymphoma appears to have a good prognosis, further clinical experience and long-term follow-up are needed to identify prognostic factors.

Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma

AbstractThe diagnostic procedure of chronic pulmonary opacities may envisage the search for non-Hodgkin lymphoma (NHL). Previous retrospective studies have shown that clonality analysis of bronchoalveolar B lymphocytes could reflect the clonality of pulmonary lymphocytes. Our objective was to define the diagnostic usefulness of bronchoalveolar lavage (BAL) B-lymphocyte clonality analysis in the setting of a clinical suspicion of both primary and secondary pulmonary lymphoma. A prospective BAL fluid B-cell clonality analysis was performed by polymerase chain reaction (PCR) in 106 consecutive patients presenting with a clinical suspicion of pulmonary NHL. Diagnosis was pulmonary B-cell lymphoma for 22 patients (13 primary and 9 secondary). When compared, pulmonary biopsy and BAL fluid have clonal identity. The detection of a strong B-cell clonal population in BAL fluid was associated with the diagnosis of pulmonary NHL (P< .0001), with a 97% specificity and a 95% negative predictive value. Thus, the absence of a dominant B-cell clone detection in BAL fluid could help to dismiss invasive investigations of pulmonary lesions. The detection of a dominant B-cell clone would lead to the performance of a pulmonary biopsy to get histologic diagnosis in primary pulmonary lymphoma and, by contrast, would avoid the need for biopsy in the setting of a secondary pulmonary lymphoma. (Blood. 2004;103: 3208-3215)

Synchronous pulmonary adenocarcinoma and extranodal marginal zone/low-grade B-cell lymphoma of MALT type

A case of synchronous adenocarcinoma of lung and extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is reported. Primary pulmonary non-Hodgkin's lymphoma is relatively rare, however, the majority of these lesions are low-grade B-cell lymphomas of MALT. After the stomach, the lung is the second most common location for such latter lesions. Lung adenocarcinoma in selected countries is fast becoming the leading form of non small-cell lung carcinoma. To our knowledge, this synchronous occurrence in the lung has not been previously reported. Such associations have been primarily limited to gastric lesions where an association with Helicobacter pylori infection has been identified. This case report highlights the importance of adjunctive diagnostic investigations such as molecular techniques in conclusive analysis of synchronous cases such as ours. HUM PATHOL 32:129-132. Copyright © 2001 by W.B. Saunders Company

Primary Pulmonary AIDS-Related Lymphoma: Radiographic and CT Findings

To describe the radiographic and CT findings of primary AIDS-related lymphoma (ARL) of the lung (ARLL), and to evaluate percutaneous transthoracic needle biopsy (PTNB) in the diagnosis of primary ARLL. Seven chest radiographs and seven CT scans of HIV-infected patients with histologically proved primary pulmonary non-Hodgkin's lymphoma (PPL) were reviewed at our institution. All of the patients had fibroscopy with BAL. The diagnosis of PPL was established histologically by means of PTNB (n = 4), open-lung biopsy (n = 2), or autopsy (n = 1). All but one patient had multiple peripheral well-defined nodules of various sizes on the chest X-ray film and CT scan. One patient had a subpleural parenchymal infiltrate and another had a main peripheral mass with spontaneous cavitation. Hilar/mediastinal adenopathies and pericardial/pleural effusion were never associated with the parenchymal abnormalities. Fibroscopy with BAL was always negative. PTNB, done in six cases, was diagnostic in four cases and suggested primary ARLL in two cases. No complications occurred during these procedures. After excluding infectious causes, multiple peripheral nodules and/or masses without hilar or mediastinal adenopathies and without pleural effusion are suggestive of primary pulmonary ARL. A specific diagnosis can be obtained by means of PTNB.

Computed tomography features of primary pulmonary non-Hodgkin's lymphoma

AIM: To characterize computed tomography (CT) features of primary pulmonary lymphoma (PPL). METHODS: The CT films of six patients (five men, one woman; 63.2 ± 14.5 years) with low grade non-Hodgkins PPL were evaluated for alveolar opacities (lobar consolidation, masses or nodules, and ill-defined consolidations), peribronchial disease or bronchial wall thickening, mediastinal nodes and pleural effusion. RESULTS: Multilobar bilateral, multilobar unilateral, and unilobar unilateral involvement were present in three, one and two cases respectively. CT features were: ill-defined mainly subpleural consolidations ( n = 4), mass-like consolidation ( n = 1), lobar consolidation ( n= 1), and pleural effusion ( n = 1). Minor peribronchial disease was seen in two patients, heterogeneous enhancement in four patients, and CT-angiogram sign in one patient. There were no lymphadenopathy or lung nodules. Although the pleura were inseparable from subpleural disease, pleural enhancement was noted on magnetic resonance imaging (MRI) of a patient with lobar lymphoma. CONCLUSION: PPL is characterized by ill-defined alveolar opacities that are usually multifocal. Peribronchial disease, proximal bronchiectasis and positive CT-angiogram sign are ancillary features. MRI may be useful in further evaluation with respect to pleural or chest wall involvement.

CT manifestation of non-Hodgkin's lymphoma as a solitary pulmonary nodule in a patient with acquired immunodeficiency syndrome

We present a case of acquired immunodeficiency syndrome with primary pulmonary non-Hodgkin's lymphoma that manifested as a solitary pleura-based mass lesion. Its differentiation from an infectious process imposed a diagnostic dilemma. The importance of awareness of such an entity for earlier diagnosis is stressed.

肺原発悪性リンパ腫５例の臨床病理学的検討

Five cases of the pulmonary non-Hodgkin's lymphoma, B cell type were examined for clinicopathological, immunohistochemical and electron microscopical studies. We divided them into two groups. The first group had no symptomes and good prognosis. They were diagnosed as non-Hodgkin's lymphoma, diffuse, small cell or medium sized cell type. They histologically showed the typical “lymphoepithelial lesion” and less destructive infiltration with unclear margin of the tumor. The second group had pulmonary symtomes and poor prognosis with histology of non-Hodgkin's lymphoma, diffuse, large cell type. They showed destructive infiltration with relatively clear margin of the tumor and no lymphoepithelial lesion. There was some immunohistochemical difference between both groups. The former corresponded with MALT (muocsa-associated lymphoid tissue) lymphoma. The latter was an aggressive lymphoma and had much in common with features of nodal lymphomas. We concluded that a group of MALT lymphoma gave some characteristics of the pulmonary non-Hodgkin's lymphoma.

Pulmonary non-Hodgkin's lymphoma mimicking infection

Progressive pulmonary shadows prompted investigations which provided the diagnosis of pulmonary non-Hodgkin's lymphoma in three patients (two with the acquired immunodeficiency syndrome). Rapid progression of radiographic abnormalities seen in these three patients is unusual for pulmonary non-Hodgkin's lymphoma and mimics disease evolution commonly associated with pulmonary infections.

Pulmonary Non-Hodgkin's Lymphoma in AIDS

Whereas extralymphatic involvement is common in lymphomas associated with HIV infection, there have been few reports of pulmonary lymphoma. In 648 cases of AIDS reported in Colorado, 40 have had non-Hodgkin's lymphoma. Of these, four have had documented pulmonary involvement and are reported in detail. Clinical manifestations were nonspecific and included fever, weight loss, generalized lymphadenopathy, dyspnea, chest pain and cough. Chest roentgenograms revealed multiple nodules or interstitial infiltrates. Transbronchial biopsy failed to establish the diagnosis in all cases. Three of four patients died four to five months after appearance of pulmonary nodules; one patient with stage IE disease showed slow radiographic progression over 16 months following radiation and chemotherapy and died 18 months after appearance of pulmonary nodules. Pulmonary involvement with lymphoma should be considered in patients with HIV infection, especially if multiple nodules are seen on chest roentgenograms.

Detection of Pulmonary Lymphoma by Bronchoalveolar Lavage

A patient with bilateral interstitial infiltrates was evaluated by bronchoalveolar lavage prior to open lung biopsy. The patient was found to have lymphocytic alveolitis (34 percent lymphocytes) in which 43 percent of lymphocytes were B cells. A clonal proliferation of these B cells was suggested by the finding of monoclonal kappa light chain on the B lymphocytes. A suspected diagnosis of primary pulmonary non-Hodgkin's lymphoma was later confirmed by open lung biopsy.