Effects of microvascular density on primary pulmonary non-Hodgkin’s lymphoma (PPL)

Clinical Analysis of 50 Cases of Primary Pulmonary Lymphoma: A Retrospective Study and Literature Review

Objective: This study aimed at to raise the awareness understanding of primary pulmonary lymphoma (PPL) by analyzing the clinical manifestation, imaging, pathology, diagnosis, treatment, and prognostic features of 50 cases of PPL. Methods: The study of 50 individuals with PPL diagnosed at the First affiliated hospital of Nanchang university between January 2009 and December 2019 was performed. Results: Overall, 27 males and 23 females were enrolled, with an average age of 57.6 ± 15.6 years. The primary symptoms included, cough (n = 37), expectoration (n = 25), sputum with blood (n = 12), and chest pain (n = 12). Two individuals had Hodgkin's lymphoma and 48 patients had non-Hodgkin's lymphoma (NHL). We divided the NHL cases into mucosa-associated lymphoid tissue lymphoma (MALT) (n = 21), diffuse large B-cell lymphoma (n = 12), small lymphocytic lymphoma (n = 2), mantle B-cell lymphoma (n = 2), follicular lymphoma (n = 1), B-cell lymphoma without further classification (n = 8), and T-cell lymphoma (n = 2). The imaging findings revealed that unilateral lung involvement was more common among the patients. The longest follow-up duration up to December 2019 was 123 months with 40 surviving patients. The 5-year overall survival and progression-free survival were 46.7% and 44.4%, respectively. Age was an independent predictive factor for the 5-year survival (hazard ratio, 8.900; P = .038), (P < .05). Conclusion: PPL is a uncommon disease with atypical clinical manifestations and is often misdiagnosed. Immunohistochemistry is currently the standard used in pathologic evaluation of PPL. MALT prognosis is better in contrast with other kinds of PPL. Surgery or radiotherapy can be considered in patients with limited lesions, and chemotherapy is the first treatment option for diffuse lesions. Age of ≥ 60 years was reported as an independent adverse predictive factor.

Prognostic Value of Microvessel Density in Non-Hodgkin Lymphoma: A Meta-Analysis

BACKGROUND

Angiogenesis in non-Hodgkin lymphoma (NHL) has been investigated by a variety of studies. However, the correlation between angiogenesis and the occurrence or prognosis of NHL patients remains controversial.

METHODS

We performed a systematic and comprehensive retrieval of relevant literatures from PubMed, EMBASE, and Web of Science databases. The quality of the eligible studies was assessed using the Newcastle-Ottawa Scale (NOS).

RESULTS

Fifteen eligible studies containing a total of 1373 NHL patients were included in this study. All the eligible studies were high-quality studies scoring ≥6 points. MVD was not different between NHL and control (SMD = 0.281, 95% CI: -1.410 to 1.972, p = 0.745). High MVD was associated with advanced disease stage (OR = 1.580, 95% CI: 1.080-2.311, p = 0.018) and unfavorable OS (HR = 1.656, 95% CI: 1.366-2.009, p = 0.000) but not with PFS (HR = 1.349, 95% CI: 0.852-2.136, p = 0.201).

CONCLUSION

This meta-analysis demonstrated that high MVD was related to advanced disease stage and associated with unfavorable OS of NHL patients.

Clinical characteristics, diagnosis, treatment, and prognostic factors of pulmonary mucosa-associated lymphoid tissue-derived lymphoma

Primary pulmonary mucosa‐associated lymphoid tissue‐derived (MALT) lymphoma is a rare disease with a favorable prognosis. However, its clinical characteristics, diagnosis, treatment, and prognoses remain unclear. We retrospectively analyzed 80 patients with pathologically confirmed MALT lymphoma from 2006 to 2018. The clinical characteristics, diagnosis, treatments, and prognoses of all the 80 patients were recorded. Patients were stratified into surgery and biopsy groups, respectively, to evaluate the role of surgery in the diagnosis and treatment of MALT lymphoma. The prognoses were compared between different clinical characteristics and treatments. Pathological diagnoses were confirmed by surgery, bronchoscopy, and percutaneous biopsy. Thirty patients were treated by surgery. While MALT lymphoma was only diagnosed by bronchofiberoscopy or bercutaneous biopsy in four of 18 patients in the surgery group who underwent the procedure. Six patients received adjuvant chemotherapy and one patient received involved‐field radiotherapy in surgery group. Thirty‐one patients were treated with chemotherapy alone, one patient was treated with radiotherapy, one patient received only symptomatic and supportive treatment, and waiting and watching without treatment were recommended in 17 patients in biopsy group. Eight patients died during follow‐up and the 5‐year survival rate was 87.1%. Tumor number, treatment, and age were prognostic factors for overall survival (OS), but age was the only independent prognostic factor according to multivariate analysis. While, tumor number was the only prognostic factor in the analysis about progression‐free survival (PFS). No significant difference was found in OS or PFS between patients treated with and without surgical resection. MALT lymphoma is an indolent disease with favorable treatment outcome. Tumor number is associated with PFS and age is the only significant prognostic factor for pulmonary MALT lymphoma patients because of its indolent nature, but surgery still plays an important role in the diagnosis and treatment of MALT lymphoma.

Prognostic factors and nomogram for survival prediction in patients with primary pulmonary lymphoma: a SEER population-based study

Primary pulmonary lymphomas (PPLs) are rare lymphoproliferative malignancies arising from the lungs. The prognostic factors and optimal management of PPL have not been clearly defined due to its rarity. This study sought to characterize the significant prognostic factors and develop a validated nomogram for individualized prediction of survival outcomes in patients with PPL. A total of 2325 patients diagnosed with PPL between 1983 and 2010 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Older age at diagnosis, males, Hispanic race, non-marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue histology, Ann Arbor stage IV were significantly associated with worse OS on multivariable analysis. All treatment modalities, including chemotherapy, surgery, and radiotherapy were independent predictors of survival on univariable analysis. The nomogram built demonstrated good discriminative ability and calibration, with the C-index of 0.690 and 0.730 in the training and validation cohorts, respectively.

Update in primary pulmonary lymphomas

PURPOSE OF REVIEW

Despite the fact that primary pulmonary lymphoma (PPL) is a rare lung tumour, significant advances addressing clinical features, histological diagnosis, prognostic criteria and therapeutic management of this disease have been made within the past decade.

RECENT FINDINGS

Monoclonality and phenotyping of alveolar lymphocytes are suggestive of mucosa-associated lymphoid tissue (MALT). Detection of MALT-1 gene rearrangements in bronchoalveolar fluid cells using fluorescence in-situ hybridization techniques helps to confirm the diagnosis of MALT PPL. Fine needle aspiration-computed tomography guided biopsies as well as transbronchial/cryobiopsies provide adequate tissue material for histological evaluation. Recent publications also provide a better appreciation of newer chemotherapeutic approaches, including fludarabine and mitoxantrone with or without ritubximab for the treatment of MALT, as well as complete surgical resection if local disease is present. Prognostic factors influencing survival and optimal therapy for MALT have not been well defined, but the use of tumour microvascular density appears promising.

SUMMARY

This review outlines the implications of recent findings for clinical practice and research progress of PPL. Larger, multicentre and well designed studies are imperative to optimize the current diagnostic and therapeutic approach for this disease.

Pulmonary mucosa-associated lymphoma in a patient with von Hippel-Lindau disease

A 61-year-old female with a past medical history significant for von Hippel–Lindau (VHL) syndrome presented with multiple bilateral pulmonary lesions found on surveillance computed tomography scan. Positron emission tomography demonstrated avidity in a lesion in the right upper lobe. After an equivocal biopsy, a lobectomy via a thoracoscopic approach was performed as this lesion was concerning for a primary lung cancer. Pathology revealed a diagnosis of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. To our knowledge, this is the first reported case of a pulmonary MALT lymphoma in a patient with VHL.