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Moriyama S, Kido T, Sakamoto N, Fuchigami M, Tokito T, Okuno D, Miyamura T, Nakashima S, Hara A, Ishimoto H, Imaizumi Y, Tsuruda K, Yanagihara K, Fukuoka J, Mukae H. Pulmonary Nodular Lymphoid Hyperplasia Evaluated with Bronchoalveolar Lavage Fluid Findings: A Case Report and Review of the Literature on Japanese Patients. Intern Med 2023; 62:95-102. [PMID: 36596475 PMCID: PMC9876723 DOI: 10.2169/internalmedicine.9310-21] [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] [Indexed: 01/01/2023] Open
Abstract
Pulmonary nodular lymphoid hyperplasia (PNLH) is a very rare disease, and it is difficult to diagnose PNLH and distinguish it from mucosa-associated lymphoid tissue (MALT) lymphoma. In addition, information on bronchoalveolar lavage fluid (BALF) analyses is lacking. We herein report a 36-year-old Japanese woman diagnosed with PLNH by a surgical biopsy and analysis of BALF. The BALF showed an increase in B-cell marker-positive lymphocytes, normal patterns of B-cell clonality, mucosa-associated lymphoid tissue 1 gene, and immunoglobulin heavy chain at 14q32 translocations. We also reviewed Japanese cases of PNLH described in Japanese or English to explore the characteristics of such cases.
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Affiliation(s)
- Sakiko Moriyama
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mai Fuchigami
- Department of Laboratory Medicine, Nagasaki University Hospital, Japan
| | - Takatomo Tokito
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Daisuke Okuno
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takuto Miyamura
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shota Nakashima
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | - Kazuto Tsuruda
- Department of Laboratory Medicine, Nagasaki University Hospital, Japan
| | | | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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2
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Kido T, Ishimoto H, Ishii H, Hara K, Ozasa M, Kawabata H, Kawanami T, Suzuki Y, Yoshikawa H, Hara A, Sakamoto N, Matsumoto N, Yoshii C, Fukuoka J, Fujita M, Nakazato M, Kadota J, Mukae H, Yatera K. Combined detection of lymphocyte clonality and MALT1 translocations in bronchoalveolar lavage fluid for diagnosing pulmonary lymphomas. Sci Rep 2021; 11:23430. [PMID: 34873224 PMCID: PMC8648835 DOI: 10.1038/s41598-021-02861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Diagnosis of pulmonary lymphoma using small tissue samples is difficult and often requires surgical procedures; thus, a less invasive sampling method is desirable. We previously showed that pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma can be diagnosed by detecting MALT lymphoma translocation gene 1 (MALT1) translocations in bronchoalveolar lavage fluid (BALF) cells. Analysis of B-cell clonality based on immunoglobulin heavy chain (IGH) gene rearrangements was also reportedly useful for diagnosing pulmonary lymphoma. The aim of this prospective multicenter study was to evaluate the yet unknown diagnostic potential of combined detection of MALT1 translocations and clonality using BALF. We analyzed B- and T-cell clonality based on IGH and T-cell receptor (TCR) rearrangements together with MALT1 translocations using BALF of patients with clinically suspected pulmonary lymphomas. In total, 39 patients were evaluated and categorized into three groups: B-cell lymphoma, lymphoproliferative disorders, and other diseases. IGH rearrangement detection for B-cell lymphoma diagnosis exhibited sensitivity and specificity of 88.9% and 90.0%, respectively. TCR rearrangements were not observed in patients with B-cell lymphomas. The presence of IGH rearrangements together with the absence of TCR rearrangements indicated 96.0% specificity for the diagnosis of B-cell lymphoma. The sensitivity and specificity of MALT1 translocations for diagnosing MALT lymphoma were 28.6% and 100%, respectively. The combined detection of lymphocyte clonality and MALT1 translocations using BALF is suitable for screening and diagnosis of B-cell lymphomas. Analysis of specific genes such as MALT1 should improve the precision of B-cell lymphoma diagnosis.
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Affiliation(s)
- Takashi Kido
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan. .,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kanako Hara
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Mutsumi Ozasa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.,Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Kawabata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Toshinori Kawanami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yu Suzuki
- Department of Respiratory Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Yoshikawa
- Department of Respiratory Medicine and Infectious Disease, Faculty of Medicine, Oita University, Yufu, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Nobuhiro Matsumoto
- Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Chiharu Yoshii
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Masamitsu Nakazato
- Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Junichi Kadota
- Department of Respiratory Medicine and Infectious Disease, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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Shao L, Jiang L, Wu S, Yu L, Wang L, Huang X. Simultaneous occurrence of invasive pulmonary aspergillosis and diffuse large B-cell lymphoma: case report and literature review. BMC Cancer 2020; 20:15. [PMID: 31906982 PMCID: PMC6945787 DOI: 10.1186/s12885-019-6471-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022] Open
Abstract
Background Patients with lymphoma are at risk for developing pulmonary opportunistic infections due to immunocompromise. However, clinical reports of concurrent lymphoma and opportunistic infection at presentation are rare and often confined to single cases. A delayed diagnosis of either opportunistic infection or lymphoma usually occurs in this complex situation. Here, we report such a case and analyse 18 similar cases searched in the PubMed database to deepen clinicians’ understanding. Case presentation A 48-year-old man presented with a 3-month history of fever, cough and emaciation. High-resolution computed tomography revealed bilateral cavitating lesions of different sizes. Aspergillus fumigatus complex was identified from a bronchoalveolar lavage fluid culture. However, antifungal treatment combined with multiple rounds of antibacterial therapy was unsuccessful, and the patient’s lung lesions continued to deteriorate. Multiple puncture biopsies finally confirmed the coexistence of diffuse large B-cell lymphoma. Despite the initiation of combination chemotherapy, the patient died of progressive respiratory failure. Conclusions Synchronous pulmonary lymphoma and simultaneous opportunistic infection is rare and usually lacks specific clinical and imaging manifestations. Lymphoma should be considered as part of the differential diagnosis of patients with an opportunistic infection when treatment fails or other symptoms are present that could be considered “atypical” for the condition. Tissue biopsy is the gold standard, and multiple biopsies are essential for making the final diagnosis and should be performed upon early suspicion.
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Affiliation(s)
- Lianyou Shao
- Division of Pulmonary Medicine, Key Laboratory of Heart and Lung, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Longxiang Jiang
- Division of Pulmonary Medicine, Integrated Chinese and Western Medicine Hospital of Wenzhou, Wenzhou, Zhejiang, 325000, China
| | - Siyao Wu
- Division of Pulmonary Medicine, Key Laboratory of Heart and Lung, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Lihua Yu
- Division of Pulmonary Medicine, Key Laboratory of Heart and Lung, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Liangxing Wang
- Division of Pulmonary Medicine, Key Laboratory of Heart and Lung, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
| | - Xiaoying Huang
- Division of Pulmonary Medicine, Key Laboratory of Heart and Lung, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Akl YMK, Zawam HME, ElKorashy RIM, Ismail MS, Hanna AKM. Role of fiberoptic bronchoscopy in the diagnosis of pulmonary infiltrates in patients with hematological malignancies. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2018. [DOI: 10.4103/ejb.ejb_107_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Yao D, Zhang L, Wu PL, Gu XL, Chen YF, Wang LX, Huang XY. Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study. BMC Cancer 2018. [PMID: 29530011 PMCID: PMC5848441 DOI: 10.1186/s12885-018-4184-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The primary pulmonary lymphoma (PPL), with a low incidence, was highly misdiagnosed in clinic. The present study analyzes the clinical features, laboratory and imaging data, pathologic characteristics, and summarizes misdiagnosis reasons of PPL cases, aims to provide a better understanding and increase the accuracy of early diagnosis and minimize the misdiagnosis of PPL. Methods The clinical data of 19 cases were collected from the first affiliated hospital of Wenzhou medical university (PRC) from April 2010 to May 2016. All cases were confirmed by pathology. The process of misdiagnosis was described. This study retrospectively analyzed the incidence, clinical presentation, laboratory examination, Chest CT scan and diagnosis of the cases. Results The symptoms of the 19 cases were dyspnea, fever, hemoptysis, chest pain or physical findings without obvious symptoms. Five patients were pneumonia-like, nine patients had lung single nodule or mass and four patients got pleural effusion, which were reported by computed tomography (HRCT) scan. There were 2 cases of Hodgkin lymphoma (HL), and 17 cases of non-Hodgkin lymphoma (NHL). In NHL cases, 12 cases were confirmed mucosa associated lymphoid tissue B lymphoma type, 3 cases were confirmed diffuse large B-cell lymphoma, angioimmunoblastic T-cell lymphoma and ALK positive anaplastic large cell lymphoma were one case separately. Clinical and imaging manifestation of PPL is untypical, but there are still some hints: 1) Fuzzy shadow at the edge of lung mass with air bronchogram; 2) Lung mass shadow stable for a long time; 3) Pneumonia-like changing without infections clinical and lab manifestation. Thirteen patients (68.4%) were misdiagnosed as pneumonia, lung cancer and tuberculosis initially. The term between initial diagnosis and final diagnosis lasted for half a month up to 2 years, with median time of 6 months. Two cases were misdiagnosed as tuberculosis. One case was misdiagnosed as small cell lung cancer. Conclusion Clinical and imaging manifestation of PPL is untypical. Biopsies should be taken actively if the imaging findings don’t match the symptoms or the anti-infection treatments to “lung infection” don’t work. Accurate diagnosis requires adequate tissue sampling with appropriate ancillary pathologic studies. If clinical manifestation and the diagnosis don’t match, repeated biopsy should be ordered.
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Affiliation(s)
- D Yao
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - L Zhang
- Wenzhou Medical University, Zhejiang, 325035, China
| | - P L Wu
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - X L Gu
- Wenzhou Medical University, Zhejiang, 325035, China
| | - Y F Chen
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - L X Wang
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - X Y Huang
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China.
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Dong Y, Zeng M, Zhang B, Han L, Liu E, Lian Z, Liu J, Liang C, Zhang S. Significance of imaging and clinical features in the differentiation between primary and secondary pulmonary lymphoma. Oncol Lett 2017; 14:6224-6230. [PMID: 29113271 PMCID: PMC5661413 DOI: 10.3892/ol.2017.6962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 07/11/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to analyze the differences in imaging and clinical features between primary pulmonary lymphoma (PPL) and secondary pulmonary lymphoma (SPL) to provide insight into pulmonary lymphoma for an improved clinical diagnosis. A retrospective study of 38 patients with pulmonary lymphoma (19 PPL and 19 SPL) treated between September 1, 2006, and December 31, 2015, was performed. The clinical manifestations, and computed tomography (CT) and positron emission tomography-CT images of each case were collected. χ2 and Fisher's exact tests were applied to assess statistically significant differences between PPL and SPL in terms of clinical and imaging features. The significant variables were further applied to canonical discriminate analysis. The CT results revealed that the occurrence of a >3-cm mass (P=0.007), peripheral location (lower than the segmental bronchi) (P=0.027), cavitation (P=0.008) and consolidation (P=0.027) were associated with PPL, while peripheral and hilar location (P=0.003) or mediastinal and hilar lymph node engagement (P=0.044) were predominantly observed in SPL. However, no significant differences between clinical manifestations and the maximum standard uptake value of pulmonary lesions in PPL and SPL were identified (all P>0.05). A function derived from discriminate analysis was generated that may predict the affiliation to PPL or SPL radiographically, with an overall accuracy of ≤92.1%. The results of the present study revealed that PPL and SPL exhibit distinctive features on CT images due to distinct molecular mechanisms and growth patterns. Careful observation of CT features may be useful in the diagnosis of PPL and SPL regarding the tumor morphology, location and lymph node involvement.
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Affiliation(s)
- Yuhao Dong
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
- Graduate College, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Miaoyu Zeng
- Graduate College, Southern Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Bin Zhang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Lujun Han
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510120, P.R. China
| | - Entao Liu
- Department of Nuclear Medicine, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
| | - Zhouyang Lian
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Jing Liu
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Changhong Liang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
| | - Shuixing Zhang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
- Correspondence to: Dr Shuixing Zhang, Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, 106 Zhongshan Er Road, Guangzhou, Guangdong 510080, P.R. China, E-mail:
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Rashidfarokhi M, Gupta J, Leytin A, Epelbaum O. Ectopic Anterior Mediastinal Pathology in the Chest: Radiologic-pathologic Correlation of Unexpected Encounters with the "Terrible Ts". J Clin Imaging Sci 2016; 6:49. [PMID: 28123839 PMCID: PMC5209860 DOI: 10.4103/2156-7514.197025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022] Open
Abstract
The complex embryology of the anterior mediastinum makes it home to an array of primary neoplasms tied to the presence of the thyroid and thymus glands in that compartment. While the occurrence of ectopic thyroid deposits in the extramediastinal thorax has not been convincingly established, the other three “Ts” of the classic “4T” mnemonic for the differential diagnosis of an anterior mediastinal mass have occurred in the lung parenchyma, pleural space, and endobronchially as primary tumors. Finding any of the three lesions – thymoma, teratoma, or B-cell lymphoma – in the chest outside the mediastinum is very unusual, but that possibility exists. Herein, we illustrate examples of this rare phenomenon.
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Affiliation(s)
- Mahsan Rashidfarokhi
- Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY 11373, USA
| | - Jessica Gupta
- Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY 11373, USA
| | - Anatoly Leytin
- Department of Pathology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY 11373, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA
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8
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Merveilleux du Vignaux C, Girard N, Salles G, Cordier JF. [Mucosa-associated lymphoid tissue-derived (MALT) lymphoma]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:95-100. [PMID: 26850454 DOI: 10.1016/j.pneumo.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 10/05/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023]
Abstract
Pulmonary Mucosa-Associated Lymphoid Tissue (MALT)-type lymphoma is the most frequent primary pulmonary lymphoma. We report the case of a patient who presented a pulmonary MALT-type lymphoma treated with chloraminophen, with a recurrence 5 years later characterized with pulmonary lesions associated with a gastric location. This observation underlines some anatomical and clinical aspects of pulmonary MALT-type lymphoma, and leads to discuss the evolution of its physiopathological and therapeutic concepts. In particular, the contributions of positron emission tomography and molecular biology allow the analysis of possible multifocal affections of this disease.
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Affiliation(s)
- C Merveilleux du Vignaux
- Service de pneumologie, centre de référence des maladies pulmonaire rares, unité pilote pour la prise en charge des tumeurs malignes rares de l'adulte, hôpital Louis-Pradel, Hospices Civils de Lyon, 69677 Lyon, France
| | - N Girard
- Service de pneumologie, centre de référence des maladies pulmonaire rares, unité pilote pour la prise en charge des tumeurs malignes rares de l'adulte, hôpital Louis-Pradel, Hospices Civils de Lyon, 69677 Lyon, France.
| | - G Salles
- Service de pneumologie, centre de référence des maladies pulmonaire rares, unité pilote pour la prise en charge des tumeurs malignes rares de l'adulte, hôpital Louis-Pradel, Hospices Civils de Lyon, 69677 Lyon, France; Service d'hématologie clinique, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France
| | - J-F Cordier
- Service de pneumologie, centre de référence des maladies pulmonaire rares, unité pilote pour la prise en charge des tumeurs malignes rares de l'adulte, hôpital Louis-Pradel, Hospices Civils de Lyon, 69677 Lyon, France
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9
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Borie R, Wislez M, Antoine M, Copie-Bergman C, Thieblemont C, Cadranel J. Pulmonary mucosa-associated lymphoid tissue lymphoma revisited. Eur Respir J 2016; 47:1244-60. [PMID: 26797028 DOI: 10.1183/13993003.01701-2015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022]
Abstract
This general review sought to clarify the pathophysiological, diagnostic, prognostic, and therapeutic features of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma.MALT lymphoma is the most common pulmonary B-cell lymphoma, which usually occurs in the context of acquired MALT. The disease is slow-growing with an asymptomatic chronic alveolar opacity visible on radiography. Diagnosis requires tissue samples that should be retrieved using minimally invasive techniques, such as bronchoscopy or computed tomography-guided biopsies. The pathophysiology includes cytogenetic abnormalities and autoimmune diseases, whereas an association with a chronic pulmonary infection is still suspected but not yet demonstrated. Disease prognosis is typically excellent and the current available treatments are discussed in this review, including the decision not to treat, surgery, and single- or double-agent chemotherapy.
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Affiliation(s)
- Raphael Borie
- Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, AP-HP, Hôpital Bichat, Paris, France
| | - Marie Wislez
- Service de Pneumologie, Centre de compétences maladies pulmonaires rares, AP-HP, Hôpital Tenon, Paris, France GRC-THERANOSCAN, Université P&M Curie, Université Paris 6, Paris, France
| | - Martine Antoine
- GRC-THERANOSCAN, Université P&M Curie, Université Paris 6, Paris, France Service d'Anatomie pathologique, AP-HP, Hôpital Tenon, Paris, France
| | | | - Catherine Thieblemont
- Service d'Hémato-oncologie, AP-HP, Hôpital Saint-Louis, Université Diderot, Sorbonne Paris Cité, Paris, France
| | - Jacques Cadranel
- Service de Pneumologie, Centre de compétences maladies pulmonaires rares, AP-HP, Hôpital Tenon, Paris, France GRC-THERANOSCAN, Université P&M Curie, Université Paris 6, Paris, France
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10
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Abstract
This review will describe the current knowledge in the pathophysiology, diagnosis, prognosis and treatment of pulmonary MALT (Mucosa Associated Lymphoid Tissue) lymphoma. Pulmonary MALT lymphomas are low-grade B cell lymphoma and are the most frequent lymphomas arising from the lung. Tumour cells arise from mucosa associated lymphoid tissue. Unlike other sites, no pathogen has been associated with pulmonary location of MALT lymphoma. However addictive translocations involving the MALT1 gene are frequently evidenced Patients are frequently asymptomatic and present with a chronic alveolar opacity. Diagnosis requires histology that may be retrieved by minimally invasive procedures during bronchial endoscopy or by CT scan guided percutaneous biopsies. Prognosis is good and treatment may vary with abstention, surgery, radiotherapy, immunotherapy or chemotherapy.
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11
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Girard N. Les tumeurs pulmonaires rares. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Borie R, Wislez M, Fleury-Feith J, Delfau-Larue MH, Cadranel J. MALT1 Rearrangements in BAL Fluid. Chest 2012; 142:262. [PMID: 22796854 DOI: 10.1378/chest.12-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Raphael Borie
- Service de Pneumologie et Réanimation, Centre de Compétence Maladies Rares Pulmonaires, Paris, France; Service de Pneumologie A, Centre de Compétence Maladies Rares Pulmonaires, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Marie Wislez
- Service de Pneumologie et Réanimation, Centre de Compétence Maladies Rares Pulmonaires, Paris, France; Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France
| | - Jocelyne Fleury-Feith
- Service d'histologie et Biologie Tumorale, Hôpital Tenon, Paris, France; Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France
| | - Marie-Helene Delfau-Larue
- Laboratoire d'Immunologie Biologique, Centre Hospitalier Henri Mondor and INSERM U955, UPEC, UFR de medecine, Creteil, France
| | - Jacques Cadranel
- Service de Pneumologie et Réanimation, Centre de Compétence Maladies Rares Pulmonaires, Paris, France; Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France
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Clonality and phenotyping analysis of alveolar lymphocytes is suggestive of pulmonary MALT lymphoma. Respir Med 2011; 105:1231-7. [PMID: 21481576 DOI: 10.1016/j.rmed.2011.03.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 03/21/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphoma, a low-grade B-cell extranodal lymphoma, is the most frequent subset of primary pulmonary lymphoma (PPL). It often associates with connective tissue disease (CTD). We aimed to evaluate the impact of concomitant CTD on diagnostic value of flow cytometry and genetic clonality analyses for the diagnostic of MALT lymphoma. METHODS All chest disease and pathology departments of teaching hospitals in Paris were contacted to identify patients with a histological diagnosis of PPL of the MALT subtype with or without associated CTD. We identified 44 patients in the lymphoma group; 11 had a CTD and were matched to 11 patients with CTD but without lymphoma. RESULTS Results of BAL analyses of MALT-PPL showed normal cellularity (370 cells/mm(3) [range 21-2300]) but increased proportion of lymphocytes (31.5% [80-2]) of the B-cell subtype (20% [1-88]). A B-cell clone was detected in 82% of cases, and specificity of clonality was 90%. Interestingly, BAL analysis results different by presence or not of a CTD. The frequency of B lymphocyte alveolitis was significantly greater in MALT patients without than with CTD (34% vs 6.5%, p = 0.007). However, BAL results for patients with CTD did not differ between those with and without lymphoma. CONCLUSION BAL results may be highly suggestive of pulmonary MALT lymphoma. The proportion of B-cells may vary depending on the presence of an associated CTD, but clonality analyses remained informative for the diagnostic of MALT lymphoma.
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Hatron PY, Tillie-Leblond I, Launay D, Hachulla E, Fauchais AL, Wallaert B. Pulmonary manifestations of Sjögren's syndrome. Presse Med 2010; 40:e49-64. [PMID: 21194883 DOI: 10.1016/j.lpm.2010.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/12/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022] Open
Abstract
Sjögren's syndrome is a chronic inflammatory disorder characterized by lymphocytic infiltration of exocrine glands, mainly the lacrimal and salivary glands. However, extraglandular organ systems may frequently be involved, including the lungs. Although subclinical pulmonary inflammation exists in more than 50% of patients, clinically significant pulmonary involvement affects approximately 10% of patients and may be the first manifestation of the disease. The entire respiratory tract may be involved, with a wide spectrum of manifestations including xerotrachea and bronchial sicca, obstructive small airway disease, various patterns of interstitial lung disease, lymphoinfiltrative or lymphoproliferative lung disease, such as lymphoma (usually of MALT type), pulmonary hypertension, pleural involvement, lung cysts, and pulmonary amyloidosis.
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Affiliation(s)
- Pierre-Yves Hatron
- Service de médecine interne, Centre national de référence des maladies systémiques et auto-immunes rares (sclérodermie), université Lille2, CHRU de Lille, place de Verdun, 59037 Lille, France.
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15
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Lévy M, Copie-Bergman C, Molinier-Frenkel V, Riou A, Haioun C, Gaulard P, Delfau-Larue MH, Sobhani I, Leroy K, Delchier JC. Treatment of t(11;18)-positive gastric mucosa-associated lymphoid tissue lymphoma with rituximab and chlorambucil: clinical, histological, and molecular follow-up. Leuk Lymphoma 2009; 51:284-90. [DOI: 10.3109/10428190903431820] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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16
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[Contribution of bronchoalveolar lavage to the diagnosis of diffuse interstitial lung diseases]. Ann Pathol 2009; 29 Spec No 1:S98-102. [PMID: 19887271 DOI: 10.1016/j.annpat.2009.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/28/2009] [Indexed: 11/21/2022]
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17
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Fretz G, Krause M, Thurnheer R. Chronic lymphocytic leukaemia, dyspnoea and "tree-in-bud" sign on chest CT scan. BMJ Case Rep 2009; 2009:bcr03.2009.1672. [PMID: 21853008 DOI: 10.1136/bcr.03.2009.1672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic lymphocytic leukaemia (CLL) is a common disorder. Patients typically present with lymphadenopathy, splenomegaly and marked lymphocytosis (often >100 000/μl). Although pulmonary involvement from CLL can be found in more than one third of patients on autopsy, respiratory symptoms caused by the disease itself are not often reported. Pulmonary involvement mainly includes parenchymal infiltrates, peribronchial and perivascular infiltration, recurrent bacterial pneumonia, oedema or infarction, pleural effusions, and lymphadenopathy. Occasionally, patients may present with dry cough and progressive dyspnoea, even with low peripheral white blood cell count. We report a case of CLL and dyspnoea at rest, predominant "tree-in-bud" sign on chest computed tomography scan, and biopsy proven bronchiolar infiltration with monoclonal lymphocytes. With bronchoalveolar lavage alone, the diagnosis would have been missed. Chemotherapy with rituximab, cyclophosphamide, and fludarabinphosphate led to a prompt clinical and radiological improvement with a gain in 6 min walking distance from 60 to 210 m.
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Affiliation(s)
- Gregory Fretz
- Kantonsspital Muensterlingen, Pulmonary Medicine, Kantonsspital, Münsterlingen, Münsterlingen, 8596, Switzerland
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18
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19
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Ishikawa CC, Ab'Saber AM, Parra ER, Lin CJ, Barbas CSV, Capelozzi VL. [Immunophenotyping and gene rearrangement analysis in lymphoid/lymphoproliferative disorders of the lungs]. J Bras Pneumol 2008; 33:625-34. [PMID: 18200361 DOI: 10.1590/s1806-37132007000600004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 04/11/2007] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the usefulness, in routine practice, of using polymerase chain reaction to analyze B and T lymphocyte clonality in pulmonary tissue as a tool for the diagnosis of pulmonary lymphoproliferative disorders. METHODS Immunohistochemistry and molecular gene rearrangement analysis were performed in order to assess 8 cases of lymphoid interstitial pneumonia (LIP) and 7 cases of pulmonary lymphoproliferative disorders. RESULTS All 8 cases of LIP presented moderate to strong immunostaining for CD3, compared with only 2 cases of lymphoma and 1 case of pseudolymphoma (p = 0.02). Gene rearrangement was detected in 4 of the 8 cases, which changed the diagnosis from LIP to lymphoma, showing the importance of gene rearrangement detection in cases of LIP. In this situation, gene rearrangement using the VH/JH and Vgamma11/Jgamma12 primer pairs was detected in 3 cases and 1 case, respectively, and no gene abnormalities were found using the Dbeta1/Jbeta2 and Vgamma101/Jgamma12 primer pairs in any of the cases. A significant positive association was found between the intensity of CD20 and CD68 expression and gene rearrangement using the VH/JH primer pair. Prior to the gene rearrangement, 4 patients with LIP died quickly, whereas only one patient with LIP died after the gene rearrangement. CONCLUSIONS Detection of monoclonal B and T cells by immunophenotyping and polymerase chain reaction had an impact on the diagnosis of pulmonary lymphomas in patients previously diagnosed with LIP. Therefore, immunophenotyping and polymerase chain reaction should be used as 'gold standard' techniques in routine practice.
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Primary cystic lung light chain deposition disease: a clinicopathologic entity derived from unmutated B cells with a stereotyped IGHV4-34/IGKV1 receptor. Blood 2008; 112:2004-12. [PMID: 18483396 DOI: 10.1182/blood-2007-11-123596] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We have recently described a new form of light chain deposition disease (LCDD) presenting as a severe cystic lung disorder requiring lung transplantation. There was no bone marrow plasma cell proliferation. Because of the absence of disease recurrence after bilateral lung transplantation and of serum-free light chain ratio normalization after the procedure, we hypothesized that monoclonal light chain synthesis occurred within the lung. The aim of this study was to look for the monoclonal B-cell component in 3 patients with cystic lung LCDD. Histologic examination of the explanted lungs showed diffuse nonamyloid kappa light chain deposits associated with a mild lymphoid infiltrate composed of aggregates of small CD20(+), CD5(-), CD10(-) B lymphocytes reminiscent of bronchus-associated lymphoid tissue. Using polymerase chain reaction (PCR), we identified a dominant B-cell clone in the lung in the 3 studied patients. The clonal expansion of each patient shared an unmutated antigen receptor variable region sequence characterized by the use of IGHV4-34 and IGKV1 subgroups with heavy and light chain CDR3 sequences of more than 80% amino acid identity, a feature evocative of an antigen-driven process. Combined with clinical and biologic data, our results strongly argue for a new antigen-driven primary pulmonary lymphoproliferative disorder.
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21
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Solomonov A, Zuckerman T, Goralnik L, Ben-Arieh Y, Rowe JM, Yigla M. Non-Hodgkin's lymphoma presenting as an endobronchial tumor: report of eight cases and literature review. Am J Hematol 2008; 83:416-9. [PMID: 18175356 DOI: 10.1002/ajh.21112] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) involving the endobronchial tree is uncommon, and the initial presentation of NHL as an endobronchial tumor is extremely rare. In a series of 441 patients with newly diagnosed non-Hodgkin's lymphoma over a 7-year period, we reviewed the clinical features of eight patients who presented with an endobronchial tumor. All patients had local pulmonary disease without extrathoracic involvement. The major presenting symptoms were dyspnea, chest pain, cough, and hoarseness. None of the patients had systemic symptoms. Radiographs revealed lobar collapse in all cases. Five patients had mediastinal masses and three had isolated endobronchial lesions. Although MALT lymphoma is the most common primary pulmonary lymphoma, it was present in only one of our patients, while seven patients had aggressive lymphoma. All patients received chemotherapy. Six of the eight patients responded favorably to treatment with complete remission. The prognosis of patients with isolated endobronchial lymphoma is not worse than other local presentations of lymphoma. Bronchoscopic examination with biopsy is essential to differentiate these lesions from primary bronchongenic carcinoma.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bronchial Neoplasms/complications
- Bronchial Neoplasms/diagnosis
- Bronchial Neoplasms/drug therapy
- Bronchial Neoplasms/pathology
- Bronchoscopy
- Cyclophosphamide/administration & dosage
- Diagnostic Imaging
- Doxorubicin/administration & dosage
- Dyspnea/etiology
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Mediastinal Neoplasms/complications
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/drug therapy
- Mediastinal Neoplasms/pathology
- Middle Aged
- Neoplasms, Second Primary/pathology
- Prednisolone/administration & dosage
- Prednisone/administration & dosage
- Pulmonary Atelectasis/etiology
- Rituximab
- Vincristine/administration & dosage
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Affiliation(s)
- Anna Solomonov
- Division of Pulmonary Medicine, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Wislez M, Antoine M, Bellocq A, Carette MF, Cadranel J. [Malt lung lymphoma]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:177-82. [PMID: 17675941 DOI: 10.1016/s0761-8417(07)90122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
MALT lung lymphoma is a low-grade primarily B-cell lymphoma. Most cases develop in a pain free patient presenting a chronic alveolar opacity. In this review, we describe the clinical radiological and pathological features as well as the diagnostic approach to this pathological entity. Prognosis is excellent. Therapeutic options are discussed.
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Affiliation(s)
- M Wislez
- Service de Pneumologie et Réanimation Respiratoire, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris Cedex 20.
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Crestani B, Schneider S, Adle-Biassette H, Debray MP, Bonay M, Aubier M. Manifestations respiratoires au cours du syndrome de Gougerot-Sjögren. Rev Mal Respir 2007; 24:535-51. [PMID: 17468709 DOI: 10.1016/s0761-8425(07)91575-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Sjogren's syndrome is a common auto-immune disease. BACKGROUND Clinically significant pulmonary involvement affects approximately 10% of patients and may be the first manifestation of the disease, putting the respiratory physician in a position to suspect and confirm the diagnosis. Besides interstitial lung disease and bronchial disorders, cough is a common symptom of the disease and particularly difficult to treat. Lung cysts and amyloid deposits, sometimes associated with lymphoma, have recently been described. The development of a primary pulmonary lymphoma, usually from MALT, is a major complication of the disease. VIEWPOINT Characterisation of the pathophysiology of pulmonary involvement in Sjogren's syndrome and the institution of specific treatment merits the interest of the respiratory physician. CONCLUSION The respiratory physician should consider the diagnosis of Sjogren's syndrome in many different clinico-pathological situations.
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Affiliation(s)
- B Crestani
- Service de Pneumologie A, APHP, Hôpital Bichat, Paris, France.
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Dhedin N, Rivaud E, Philippe B, Scherrer A, Longchampt E, Honderlick P, Catherinot E, Vernant J, Couderc L. Approche diagnostique d’une pneumopathie chez un malade atteint d’hémopathie maligne. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91038-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
Primary pulmonary lymphoma (PPL) is a rare disease with a favorable prognosis compared with lung cancer. Although a number of histologic variables of B- and T-cell lymphoma were reported as PPL, marginal zone lymphoma of the mucosa-associated lymphoid tissue type is by far the most frequent diagnosis. This review summarizes the present knowledge of histopathology, molecular biology, diagnosis, prognosis, and treatment of this heterogeneous entity.
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Affiliation(s)
- Luciano Wannesson
- Department of Medical Oncology, Institute of Southern Switzerland, Bellinzona, Switzerland
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26
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Inagaki H, Li C, Okabe M, Nishikawa M, Nishikawa AM, Iida S, Ueda R. Detection of API2-MALT1 Fusion Transcripts in Cytologic Specimens of Patients with Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma. Int J Hematol 2005; 82:59-62. [PMID: 16105761 DOI: 10.1532/ijh97.05016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma constitutes up to 90% of primary pulmonary lymphomas, but its diagnosis is often difficult. API2-MALT1 fusion is specific to MALT lymphoma and is detected in nearly half of the pulmonary cases. Cytologic examinations have played a pivotal role in the diagnosis of pulmonary tumors; however, cytologic specimens have only infrequently been used for molecular studies. In this study, we performed a multiplex reverse transcription-polymerase chain reaction (RT-PCR) assay to detect the API2-MALT1 fusion transcript in archival cytologic specimens used as RNA sources. We studied 3 pulmonary MALT lymphoma cases that were positive for the fusion gene as detected with RNA extracted from diagnostic histologic specimens. In 1 case, a conventional PCR clonality assay for the immunoglobulin heavy chain gene rearrangement failed to detect the monoclonality. In all 3 cases, the fusion transcript was successfully detected in the cytologic specimens of sputum, bronchoalveolar lavage fluid, bone marrow smears, and pleural effusions. This finding suggests that such specimens can be used as RNA sources in multiplex RT-PCR assays for the API2-MALT1 fusion transcript. The detection of API2-MALT1 fusion as carried out with these specimens would be useful as an ancillary assay for the diagnosis, staging, and follow-up of pulmonary MALT lymphoma.
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MESH Headings
- Aged
- Aged, 80 and over
- Bronchoalveolar Lavage Fluid/cytology
- Cytological Techniques
- Humans
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/physiopathology
- Male
- Middle Aged
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/biosynthesis
- Oncogene Proteins, Fusion/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Specimen Handling
- Sputum/cytology
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Affiliation(s)
- Hiroshi Inagaki
- Department of Pathology, Graduate School of Medical Sciences, Nagoya City University, Nagoya.
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27
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Israel-Biet D, Danel C. [Contribution of bronchoalveolar lavage to the management of interstitial lung disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2005; 61:141-8. [PMID: 16142186 DOI: 10.1016/s0761-8417(05)84805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Bronchoalveolar lavage (BAL) is a minimally invasive method for exploring the distal lung. It enables collection of free cellular and acellular material present in the alveoli. Over the last two decades BAL has become a fundamental tool for positive diagnosis of interstitial lung disease and even more for differential diagnosis. It has contributed greatly to the diagnosis of lung infections, particularly in immunosuppressed patients. In the context of non-infectious infiltrative disease, the diagnostic contribution of BAL is limited due to the lack of a specific cell profile. It remains a fundamental tool for the differential diagnosis of idiopathic interstitial pneumonia. With BAL, a number of infectious or tumoral diseases can be ruled out with precision. It is also an important element for the evaluation of possible iatrogenic disease. BAL has transformed the diagnosis of interstitial lung disease and considerably reduced the indications for surgical biopsy.
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Affiliation(s)
- Dominique Israel-Biet
- Service de Pneumologie, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, Faculté de Médecine Paris-5.
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Ito I, Nagai S, Kitaichi M, Nicholson AG, Johkoh T, Noma S, Kim DS, Handa T, Izumi T, Mishima M. Pulmonary manifestations of primary Sjogren's syndrome: a clinical, radiologic, and pathologic study. Am J Respir Crit Care Med 2004; 171:632-8. [PMID: 15579729 DOI: 10.1164/rccm.200403-417oc] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Clinicopathologic pulmonary manifestations associated with primary Sjogren's syndrome have yet to be reviewed in a large series since the recognition of nonspecific interstitial pneumonia (NSIP) as a distinct histologic pattern. OBJECTIVES To determine clinical presentations, high-resolution computed tomographic (HRCT) and histologic findings of the lung disease associated with primary Sjogren's syndrome in the light of NSIP, and to analyze prognosis of the disease. METHODS On the basis of 33 cases (31 surgical lung biopsies and 2 autopsies) collected consecutively from multiple centers, we have retrospectively evaluated clinical, radiologic, and pathologic manifestations of the disease. Prognostic factors were identified by univariate and multivariate analysis. MEASUREMENTS AND MAIN RESULTS We found that NSIP was the most frequently seen histologic pattern (20 of 33 cases [61%], 19 fibrosing and 1 cellular). Bronchiolar diseases and amyloid and malignant lymphoma were seen less frequently. HRCT-pathologic correlation resulted in a 94% positive predictive value of CT-NSIP pattern for pathologic diagnosis of NSIP, whereas the diagnostic value of HRCT was low (15%) with an HRCT pattern other than NSIP, data that may influence the decision to biopsy. The 5-year survival rate was 84% overall and 83% in patients with NSIP. Multivariate analysis on all patients showed that low Pa(O(2)) (p = 0.02) and presence of microscopic honeycombing (p = 0.04) were independently associated with survival. Patients with NSIP showed lower vital capacity (mean +/- SD: 68.5 +/- 16.6%pred) than patients without NSIP (92.5 +/- 18.6%pred; p < 0.001). CONCLUSION Among a diversity of pulmonary lesions in primary Sjogren's syndrome, NSIP was the commonest histologic pattern and had a favorable prognosis.
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Affiliation(s)
- Isao Ito
- Department of Respiratory Medicine, Kyoto University Hospital, 54 Shogoin-kawaharacho, Sakyo, Kyoto, Japan
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