Primary pulmonary Hodgkin's disease. A clinicopathologic study of 15 cases

Fifteen cases of primary pulmonary Hodgkin's disease are reported. This presentation of Hodgkin's disease occurred more frequently in women (2:1) and older individuals, and B symptoms were relatively common (7 of 13). The majority of patients had nodular lesions on chest radiographs. An unfavorable prognosis was linked to B symptoms, older age (greater than 60 years) and multiplicity and bilaterality of lung lesions. The histologic differential diagnosis is discussed, particularly in regard to Wegener's granulomatosis and non-Hodgkin's lymphomas.

Angiosarcoma presenting in the lung

Three cases of angiosarcoma presenting as diffuse pulmonary infiltrates are described and the clinical presentations, histologic findings, and differential diagnosis are discussed. Primary pulmonary angiosarcomas are extremely rare and require careful clinical evaluation to exclude metastases from the heart, pericardium, pulmonary arterial trunk, and distant extrathoracic sites.

Isolated pulmonary rejection after combined heart-lung transplantation

Severe pulmonary rejection without cardiac rejection in a patient after combined heart-lung transplantation is presented with the clinical and pathological findings. Acute lung rejection after heart-lung transplantation cannot be excluded by normal cardiac biopsy results.

Pathologic pulmonary alterations in long-term human heart-lung transplantation

Twenty-one patients with end-stage pulmonary hypertension underwent combined allograft heart-lung transplantation after 1980. Almost 80 per cent of these patients survived beyond the immediate postoperative period, with the longest survival period more than 3 1/2 years at the time of this report. Five patients died in the perioperative or immediate postoperative period, and 11 returned to normal lives with essentially normal pulmonary function. In the remaining five allograft recipients recurrent respiratory infections and progressive obstructive airway disease developed, with superimposed restrictive deficits in three of them. Two open lung biopsies, two autopsies, and one retransplantation were performed in these recipients. Morphologically, these allograft recipients showed extensive bronchiolitis obliterans, interstitial and pleural fibrosis, and accelerated arterial and venous arteriosclerosis. Bronchiolitis obliterans may prove to be a significant complication of heart-lung transplantation.

Pulmonary lymphoid neoplasms

The majority of pulmonary lymphomas have a distribution that follows lymphatic routes and a monomorphous (in the case of lymphocytic and large-cell lymphomas) cell population. Mixed-cell lymphomas show a similar distribution and a cytologic composition identical to mixed-cell lesions in lymph nodes. The term homogeneous may be preferable to monomorphous for lymphoplasmacytic lymphomas (such as Waldenström's macroglobulinemia) and mixed cell lymphomas, as their composition is similar from field to field in contrast to inflammatory lesions, which show geographic cellular heterogeneity and variable scarring.

Follicular bronchitis/bronchiolitis

Nineteen open lung biopsies demonstrating follicular bronchitis/bronchiolitis were reviewed with special attention to clinical manifestations. Morphologically, follicular bronchitis/bronchiolitis was represented by coalescent reactive germinal centers adjacent to airways in the absence of clinical or pathologic evidence of chronic obstructive pulmonary disease or bronchiectasis. Three clinicopathologic groups were identified: 1) patients with collagen vascular diseases, especially rheumatoid arthritis and Sjögren's syndrome; 2) patients with a familial form of the disease or with immunodeficiency syndromes; and 3) a heterogeneous group of patients with frequent peripheral blood eosinophilia, suggesting a hypersensitivity reaction. Prognosis was related to age at the time of biopsy and, to some extent, to the clinical group. Steroid therapy had inconsistent effects in all groups identified. The differential diagnosis of lymphoid lesions in the lung is also discussed.

Chemotherapy-induced eosinophilic pneumonia. Relation to bleomycin

Three cases of eosinophilic pneumonia are associated with bleomycin chemotherapy. As opposed to the more common picture of diffuse alveolar damage, these cases appear to represent a hypersensitivity reaction resembling eosinophilic pneumonia.

Non-Hodgkin's lymphomas of the lung. A study of 19 cases emphasizing the utility of frozen section immunologic studies in differential diagnosis

Nineteen cases of possible non-Hodgkin's lymphoma of the lung were studied by conventional morphologic methods and by immunohistochemical methods employing monoclonal antibodies applied to frozen tissue sections. In five of the 19 cases, the original histologic diagnoses were revised after review of the immunologic findings. Problem areas clarified by immunodiagnosis included the differential diagnoses of pseudolymphoma versus small lymphocytic lymphoma (two cases), Hodgkin's disease versus non-Hodgkin's lymphoma (two cases) and non-Hodgkin's lymphoma versus lymphomatoid granulomatosis (one case). Of the seven lymphomas presenting exclusively in the lung without a prior history of lymphoma, three were small lymphocytic, one was diffuse mixed small cleaved and large cell, and three were diffuse large-cell lymphomas. Four of these lymphomas typed as B-cell, two typed as T-cell, and one was of undefined phenotype.

Malignant epithelioid schwannoma arising in a benign schwannoma. A case report

A case of malignant epithelioid schwannoma arising in a benign schwannoma is described. The findings were supported by morphologic criteria as well as by a clinical history of recent growth of a long-standing mass adherent to the sciatic nerve, accompanied by evidence of metastatic spread. The light microscopic, ultrastructural, and immunohistochemical features are described, and the three previous cases of malignant change in benign neurilemmomas reviewed.

Primary mediastinal non-Hodgkin's lymphomas: a morphologic and immunologic study of 19 cases

Nineteen, primary, non-lymphoblastic, non-Hodgkin's lymphomas were investigated by conventional morphologic studies as well as immunologic studies using the application of a battery of monoclonal antibodies to frozen tissue sections. Seventeen of the lymphomas were diffuse large cell; one was large cell immunoblastic and one was a follicular and diffuse lymphoma of intermediate differentiation. Thirty-seven percent of the lymphomas showed prominent sclerosis, sometimes associated with the superior vena cava syndrome. Six of the cases showed evidence of immunoglobulin production with light chain restriction. Twelve additional cases were shown to be of B-cell lineage by B1/T015 expression but did not show evidence of immunoglobulin production. One case was a T-cell lymphoma of helper phenotype. Ia expression was found in 14 of 18 cases studied.

Lung biopsy in rheumatoid arthritis

Forty open lung biopsies from patients with rheumatoid arthritis and possible "rheumatoid lung disease" were reviewed in an attempt to correlate histology with radiologic, physiologic, and prognostic variables. A wide variety of histopathologic features was seen, and primary and secondary patterns of injury were recognized. Five different groups based on histologic patterns were identified: pulmonary rheumatoid nodules, usual interstitial pneumonia (UIP), bronchiolitis obliterans with patchy organizing pneumonia (BOOP), lymphoid hyperplasia, and cellular interstitial infiltrates. The finding of rheumatoid nodules as the primary pattern imparted a uniformly good prognosis, whereas the pattern of UIP indicated a poor one. Patients with BOOP had a more favorable prognosis than did patients with UIP, as did patients with lymphoid hyperplasia and/or nonspecific cellular interstitial infiltrates. Consistent correlations between pulmonary function testing and roentgenographic and histologic findings were not found. The term "rheumatoid lung disease" is of no use as a histologic diagnosis because it encompasses a broad spectrum of morphologic changes that carry significantly different prognoses.

Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart-lung transplantation

Since March 1981, 19 patients have undergone heart-lung transplantation for end-stage pulmonary vascular disease, with 14 long-term survivors. In five of the survivors, obstructive airway disease has developed with the superimposition of a progressive restrictive ventilatory defect in three of them. None of these five patients showed a tendency for spontaneous improvement of flow rates. Biopsy and postmortem material was available in four of the five patients and showed obliterative bronchiolitis (OB) in three. A fourth patient showed clinical and physiologic data consistent with obliterative bronchitis, but histologic material was not available. Obstructive lung disease without restrictive features developed in a fifth patient, but no histologic evidence of OB was found at transbronchial biopsy. In addition to OB, recurrent lung infections were found in all patients, significant pleural fibrosis in two patients, and bronchiectasis in one patient. Despite these long-term sequelae of human heart-lung transplantation, ten of the 14 surviving patients are leading relatively normal lives.