1
|
Yamamoto M, Shindo M, Sumi C, Igarashi S, Saito T, Tsukada N, Toki Y, Hatayama M, Inamura J, Sato K, Mizukami Y, Torimoto Y, Okumura T. Acquired hemophilia A associated with Epstein-Barr-virus-associated T/natural killer-cell lymphoproliferative disease: A case report. Medicine (Baltimore) 2021; 100:e25518. [PMID: 33879690 PMCID: PMC8078394 DOI: 10.1097/md.0000000000025518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies against factor VIII (FVIII). Hematological malignancies, especially lymphoid malignancies, are known to be underlying causes of AHA; however, thus far, there is no report of AHA associated with Epstein-Barr-virus-associated T/natural killer-cell lymphoproliferative disease (EBV-T/NK-LPD). Here, we present a case of AHA that developed during treatment for EBV-T/NK-LPD. HISTORY A 69-year-old man visited our hospital because of general fatigue. Blood examination showed pancytopenia, and computed tomography revealed whole-body lymphadenopathy, but there were no findings indicating hematological malignancy from bone marrow aspiration and cervical lymph node biopsy. The level of EBV DNA in peripheral blood was extremely high, and he was diagnosed with EBV-T/NK-LPD. EBV-T/NK-LPD improved with prednisolone (PSL) administration. Seventeen months after starting treatment, the patient complained of back and right leg pain. At that time, he had been treated with low-dose PSL, and EBV-T/NK-LPD was well controlled. Imaging revealed hematoma of the right iliopsoas muscle. Prolonged activated partial thromboplastin time (APTT) was the only abnormal finding in a screening coagulation test. FVIII coagulant activity was below detection limit, and FVIII inhibitor level was increased. From these results, he was diagnosed with AHA.A higher dose of PSL was administered, and, after 1 month of treatment, FVIII activity gradually increased, and FVIII inhibitor level became undetectable. APTT also normalized, and complete remission was achieved and maintained for 13 months with low-dose PSL. During treatment, EBV-T/NK-LPD was well controlled. CONCLUSION It is speculated that proliferating lymphocytes interfere with normal immune functions and that abnormal autoantibodies are produced from those lymphocytes in patients with LPD. Therefore, we speculate that EBV-infected and proliferating monoclonal NK cells might have modulated the immune system and produced autoantibodies against FVIII, thus causing AHA in this patient with EBV-T/NK-LPD.
Collapse
Affiliation(s)
- Masayo Yamamoto
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| | - Motohiro Shindo
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| | - Chihiro Sumi
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| | - Sho Igarashi
- Department of Hematology/Oncology, Asahikawa-Kosei General Hospital
| | - Takeshi Saito
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| | - Nodoka Tsukada
- Department of Hematology/Oncology, Asahikawa-Kosei General Hospital
| | - Yasumichi Toki
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| | - Mayumi Hatayama
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| | - Junki Inamura
- Department of Hematology/Oncology, Asahikawa-Kosei General Hospital
| | - Kazuya Sato
- Department of Hematology/Oncology, Asahikawa-Kosei General Hospital
| | - Yusuke Mizukami
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| | - Yoshihiro Torimoto
- Oncology Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Toshikatsu Okumura
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University
| |
Collapse
|
2
|
Wernecke M, Frieling D, Brandl U, Feller A, von Wichert G. [EBV-positive MTX-associated lymphoproliferative disorder and Ig M myeloma in rheumatoid arthritis]. Dtsch Med Wochenschr 2021; 146:262-265. [PMID: 33592662 DOI: 10.1055/a-1328-8468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HISTORY An 80-year-old female patient arrived with a pronounced lymphadenopathy and weight loss. 6 years ago she had been diagnosed with rheumatoid arthritis. At the time of arrival, she was administered Methotrexate (MTX) 10 mg/week. FINDINGS AND DIAGNOSIS By lymph node biopsy, a clonal population of both EBV-positive B and T cells was seen. Newly occurring anemia (Hb 10 g/dl), monoclonal gammopathy of the Ig M isotype and detection of 40 % EBV-positive plasma cells in the bone marrow were consistent with the diagnosis of Ig M myeloma. We interpret these findings as a biclonal Epstein Barr Virus-positive Methotrexate-associated lymphoproliferative disorder (MTX-LPD). TREATMENT AND COURSE The clinical condition improved immediately after MTX discontinuation. In the follow-up after 4 months, the gamma globulin concentration in serum was significantly reduced (from 51.1 to 34.7 %) and a renewed immune electrophoresis of the serum was without evidence of monoclonal gammopathy. CONCLUSION Based on this case, the association of RA with lymphoproliferative disorders can be confirmed - here as an association of RA with biclonal MTX-LPD or multiple myeloma. Therapy with MTX and reactivation of EBV infection are important influencing factors.
Collapse
Affiliation(s)
| | - David Frieling
- Klinik für Diagnostische und Interventionelle Radiologie, Schönklinik Hamburg-Eilbek
| | | | | | | |
Collapse
|
3
|
Kleinstern G, Averbuch M, Abu Seir R, Perlman R, Ben Yehuda D, Paltiel O. Presence of autoimmune disease affects not only risk but also survival in patients with B-cell non-Hodgkin lymphoma. Hematol Oncol 2018; 36:457-462. [PMID: 29469175 DOI: 10.1002/hon.2498] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/21/2017] [Accepted: 01/10/2018] [Indexed: 12/26/2022]
Abstract
Although autoimmune diseases (AIDs) are known to predispose to non-Hodgkin lymphoma (NHL), their association with NHL prognosis has rarely been investigated. We examined associations between autoimmunity and B-cell NHL onset by comparing AID history (determined by self-report and medication review and supplemented by chart review where possible) among 435 adult B-NHL patients in Hadassah-Hebrew University Medical Center, diagnosed 2009-2014, and 414 age-and-sex frequency-matched controls. We examined AIDs as a whole, B- and T-cell-mediated AIDs, and autoimmune thyroid diseases. Among cases, we used Kaplan-Meier and Cox regression models to assess the association of AID with overall survival and relapse-free survival, adjusting for prognostically important patient and disease characteristics such as Ki67% staining, International Prognostic Index, rituximab treatment, and histological subgroup. Autoimmune diseases were associated with B-NHL (odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.31-2.92), especially AIDs mediated by B-cell activation (OR = 5.20; CI, 1.90-14.3), which were particularly associated with marginal zone lymphoma (OR = 19.3; CI, 4.59-80.9). We found that time to relapse for all B-NHL patients with AIDs was significantly shorter (mean of 49.21 mo [±3.22]) than among patients without AID (mean of 59.74 mo [±1.62]), adjusted hazard ratio [HRadj ] = 1.69 (CI, 1.03-2.79). Specifically, in patients with diffuse large B-cell lymphoma, of whom 91.8% had received rituximab, a history of B-cell-mediated AIDs was associated with shorter relapse-free survival and overall survival, HRadj = 8.34 (CI, 3.01-23.1) and HRadj = 3.83 (CI, 1.20-12.3), respectively. Beyond confirming the well-known association between AIDs and B-NHL, we found that AID is an adverse prognostic factor in B-cell lymphoma, associated with a shortened time to relapse, suggesting that there are specific therapeutic challenges in the subgroup of patients suffering from both these diseases. Further work is required to address mechanisms of resistance to standard treatment in the setting of AID-associated B-NHL. In the era of immunotherapy, these findings have particular relevance.
Collapse
Affiliation(s)
- Geffen Kleinstern
- School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mor Averbuch
- School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rania Abu Seir
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Medical Laboratory Sciences, Al Quds University, Abu Deis, Jerusalem
| | - Riki Perlman
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dina Ben Yehuda
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
4
|
Moling O, Piccin A, Tauber M, Marinello P, Canova M, Casini M, Negri G, Raffeiner B, Binazzi R, Gandini L, Vecchiato C, Rimenti G, Billio A. Intravascular large B-cell lymphoma associated with silicone breast implant, HLA-DRB1*11:01, and HLA-DQB1*03:01 manifesting as macrophage activation syndrome and with severe neurological symptoms: a case report. J Med Case Rep 2016; 10:254. [PMID: 27634631 PMCID: PMC5025582 DOI: 10.1186/s13256-016-0993-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 07/05/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Silicone implants have been successfully used for breast augmentation and reconstruction in millions of women worldwide. The reaction to the silicone implant is highly variable; it can lead to local inflammatory symptoms, and sometimes to systemic symptoms and disease. Over 80 cases of anaplastic lymphoma kinase-negative anaplastic large cell lymphoma have been reported in patients with silicone breast implants and have been accepted as a new clinical entity. To the best of our knowledge, an intravascular large B-cell lymphoma associated with a silicone breast implant has not been reported previously. CASE PRESENTATION A 48-year-old Caucasian woman who presented with high fever was found to have splenomegaly on physical examination. A laboratory diagnosis revealed pancytopenia, hypertriglyceridemia, and hyperferritinemia. She developed signs of altered sensorium, hemiparesis, aphasia, and cauda equina syndrome. On further evaluation, she fulfilled the necessary five out of eight criteria for diagnosis of macrophage activation syndrome/hemophagocytic lymphohistiocytosis. Dexamethasone administration was followed by prompt improvement; however, 3 days later she again manifested high fever, which persisted despite administration of immunoglobulin and cyclosporine A. Her silicone breast implant was considered a possible contributor to her macrophage activation syndrome and was therefore removed. A histological examination of the capsule tissue showed an extensive lymphohistiocytic/giant cell foreign body reaction suggestive of autoimmune/inflammatory syndrome induced by adjuvants. However, the histological examination unexpectedly also revealed an intravascular large B-cell lymphoma. CONCLUSIONS The genetic background of our patient with silicone breast implants might have predisposed her to three rare and difficult to diagnose syndromes/diseases: macrophage activation syndrome/hemophagocytic lymphohistiocytosis, autoimmune/inflammatory syndrome induced by adjuvants, and intravascular large B-cell lymphoma. The simultaneous manifestation of all three syndromes suggests causal interrelationships. Human leukocyte antigen testing in all women who undergo silicon breast implantation could in the future enable us to better evaluate the risk of potential side effects.
Collapse
Affiliation(s)
- Oswald Moling
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy.
| | - Andrea Piccin
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
| | - Martina Tauber
- Department of Pathology, Ospedale Generale, 39100, Bolzano, Italy
| | - Peter Marinello
- Department of General Surgery, Ospedale Generale, 39100, Bolzano, Italy
| | - Mariagrazia Canova
- Rheumatology Unit, Department of Medicine, Ospedale Generale, 39100, Bolzano, Italy
| | - Marco Casini
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
| | - Giovanni Negri
- Department of Pathology, Ospedale Generale, 39100, Bolzano, Italy
| | - Bernd Raffeiner
- Rheumatology Unit, Department of Medicine, Ospedale Generale, 39100, Bolzano, Italy
| | - Raffaella Binazzi
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Latha Gandini
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Cinzia Vecchiato
- Laboratory of Immunogenetics, Transfusion Medicine Service, Ospedale Generale, 39100, Bolzano, Italy
| | - Giovanni Rimenti
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Atto Billio
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
| |
Collapse
|
5
|
Law A, Shmukler A, Burns J, Haramati LB. Viruses, Immunity and Unusual Lymphoproliferative Disorders of the Chest: Integrating Imaging With Pathogenesis and Clinical Presentations. J Comput Assist Tomogr 2015; 40:71-9. [PMID: 26484956 DOI: 10.1097/rct.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unusual lymphoproliferative diseases result from the stimulation of intrathoracic lymphoid tissue by viruses and immune dysfunction, ranging from benign hyperplasia to malignant transformation. We review the clinical, radiological, and histopathological findings of unusual lymphoproliferative disorders, which have been linked to viruses or immune dysfunction, focusing on thoracic manifestations. Understanding these advances in science enhances the radiologist's skills in integrating the imaging findings to the clinical scenario to suggest the correct diagnosis.
Collapse
Affiliation(s)
- Amy Law
- From the *Department of Radiology, and †Departments of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | | | | |
Collapse
|
6
|
Bernatsky S, Ramsey-Goldman R, Joseph L, Boivin JF, Costenbader KH, Urowitz MB, Gladman DD, Fortin PR, Nived O, Petri MA, Jacobsen S, Manzi S, Ginzler EM, Isenberg D, Rahman A, Gordon C, Ruiz-Irastorza G, Yelin E, Bae SC, Wallace DJ, Peschken CA, Dooley MA, Edworthy SM, Aranow C, Kamen DL, Romero-Diaz J, Askanase A, Witte T, Barr SG, Criswell LA, Sturfelt GK, Blanco I, Feldman CH, Dreyer L, Patel NM, Pierre YS, Clarke AE. Lymphoma risk in systemic lupus: effects of disease activity versus treatment. Ann Rheum Dis 2014; 73:138-42. [PMID: 23303389 PMCID: PMC3855611 DOI: 10.1136/annrheumdis-2012-202099] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE). METHODS We performed case-cohort analyses within a multisite SLE cohort. Cancers were ascertained by regional registry linkages. Adjusted HRs for lymphoma were generated in regression models, for time-dependent exposures to immunomodulators (cyclophosphamide, azathioprine, methotrexate, mycophenolate, antimalarial drugs, glucocorticoids) demographics, calendar year, Sjogren's syndrome, SLE duration and disease activity. We used adjusted mean SLE Disease Activity Index scores (SLEDAI-2K) over time, and drugs were treated both categorically (ever/never) and as estimated cumulative doses. RESULTS We studied 75 patients with lymphoma (72 non-Hodgkin, three Hodgkin) and 4961 cancer-free controls. Most lymphomas were of B-cell origin. As is seen in the general population, lymphoma risk in SLE was higher in male than female patients and increased with age. Lymphomas occurred a mean of 12.4 years (median 10.9) after SLE diagnosis. Unadjusted and adjusted analyses failed to show a clear association of disease activity with lymphoma risk. There was a suggestion of greater exposure to cyclophosphamide and to higher cumulative steroids in lymphoma cases than the cancer-free controls. CONCLUSIONS In this large SLE sample, there was a suggestion of higher lymphoma risk with exposure to cyclophosphamide and high cumulative steroids. Disease activity itself was not clearly associated with lymphoma risk. Further work will focus on genetic profiles that might interact with medication exposure to influence lymphoma risk in SLE.
Collapse
Affiliation(s)
- Sasha Bernatsky
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rosalind Ramsey-Goldman
- Department of Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lawrence Joseph
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Karen H Costenbader
- Medicine, Division of Rheumatology, Immunolog, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Murray B Urowitz
- Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Paul R Fortin
- Infectiologie et immunologie, Université de Laval, Quebec, Quebec, Canada
| | - Ola Nived
- Division of Rheumatology, Lund University Hospital, Lund, Sweden
| | - Michelle A Petri
- Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Soren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susan Manzi
- Department of Medicine, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA
| | - Ellen M Ginzler
- Division of Rheumatology, Downstate Medical Centre, State University New York, Brooklyn, New York, USA
| | - David Isenberg
- Centre for Rheumatology Research, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, London, UK
| | - Caroline Gordon
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain
| | - Edward Yelin
- Medicine, Division of Rheumatology, University of California, San Francisco, California, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Daniel J Wallace
- Department of Medicine, Cedars-Sinai Medical Center/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christine A Peschken
- Medicine, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Anne Dooley
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven M Edworthy
- Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Aranow
- Center for Autoimmune and Musculoskeletal, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Diane L Kamen
- Division of Immunology and Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Juanita Romero-Diaz
- Division of Rheumatology and Immunology, Instituto Nacional de Cs Medicas y Nutricion, Mexico City, Mexico
| | - Anca Askanase
- Department of Medicine, Hospital for Joint Diseases, New York University, New York, New York, USA
| | - Torsten Witte
- Division of Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Susan G Barr
- Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Lindsey A Criswell
- Rosalind Russell Medical Research Center for Arthritis, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Irene Blanco
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Candace H Feldman
- Medicine, Division of Rheumatology, Immunolog, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Lene Dreyer
- Department of Rheumatology, Rigshospitalet and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Neha M Patel
- Division of Rheumatology, Downstate Medical Centre, State University New York, Brooklyn, New York, USA
| | - Yvan St Pierre
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Imaging manifestations of autoimmune disease-associated lymphoproliferative disorders of the lung. Clin Rheumatol 2013; 32:1459-65. [PMID: 23728499 DOI: 10.1007/s10067-013-2304-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 12/19/2022]
Abstract
Lymphoproliferative disorders (LPDs) may involve intrathoracic organs in patients with autoimmune disease, but little is known about the radiologic manifestations of autoimmune disease-associated LPDs (ALPDs) of the lungs. The purpose of our work was to identify the radiologic characteristics of pulmonary involvement in ALPDs. A comprehensive search for PubMed database was conducted with the combination of MeSH words. All articles which had original images or description on radiologic findings were included in this analysis. Also, CT images of eight patients with biopsy-proven lymphoproliferative disorder observed from our institution were added. Overall, 44 cases of ALPD were identified, and consisted of 24 cases of bronchus-associated lymphoid tissue lymphoma (BALToma), eight cases of non-Hodgkin's lymphoma (NHL), six cases of lymphoid interstitial pneumonia (LIP), two cases of nodular lymphoid hyperplasia, two cases of unclassified lymphoproliferative disorder, and one case each of lymphomatoid granulomatosis and hyperblastic BALT. Multiple nodules (n = 14, 32 %) and single mass (n = 8, 18 %) were the predominant radiologic manifestations. The imaging findings conformed to previously described findings of BALToma, NHL, or LIP. Data suggest that BALToma, NHL, and LIP are the predominant ALPDs of the lung, and ALPD generally shared common radiologic features with sporadic LPDs. Familiarity with ALPDs and their imaging findings may enable radiologists or clinicians to include the disease as a potential differential diagnosis and thus, to prompt early biopsy followed by appropriate treatment.
Collapse
|
8
|
Dong L, Chen Y, Masaki Y, Okazaki T, Umehara H. Possible Mechanisms of Lymphoma Development in Sjögren's Syndrome. ACTA ACUST UNITED AC 2013; 9:13-22. [PMID: 23853604 PMCID: PMC3706954 DOI: 10.2174/1573395511309010003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/28/2013] [Accepted: 05/02/2013] [Indexed: 02/08/2023]
Abstract
Primary Sjögren's syndrome (pSS) is a systemic as well as an organ-specific autoimmune disease characterized by lymphocytic infiltration of the glandular epithelial tissue. SS patients have been reported to be at highest risk of developing lymphoproliferative neoplasms, when compared with patients with other rheumatoid diseases. Factors such as cytokine stimulation, environmental factors, viral infection and genetic events as well as vitamin deficiency may contribute to the development of lymphoma. Over the past few decades, numerous efforts have been made to assess the relationship between lymphoma and SS. These include epidemiological surveys, molecular biologic assessments of clonality and well-linked register cohort studies evaluating the predictive value of clinical, laboratory and histological findings. Nevertheless, the mechanisms and factors predictive of lymphoma development in pSS patients remain to be defined. This review summarizes updated knowledge on the incidence of and risk factors for lymphoma development in pSS patients, as well as discussing the most recent findings on the development and treatment of lymphoma in pSS patients and the possible mechanism of lymphoma development.
Collapse
Affiliation(s)
- Lingli Dong
- Department of Hematology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | | | | | | | | |
Collapse
|