1
|
Common Variable Immunodeficiency and Other Immunodeficiency Syndromes in Bronchiectasis. Semin Respir Crit Care Med 2021; 42:525-536. [PMID: 34261177 DOI: 10.1055/s-0041-1730893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Immunodeficiency represents a vast number of diseases and syndromes. Both primary and secondary forms of immunodeficiency are important contributors to the development of bronchiectasis. Primary immune deficiencies, in particular, are increasingly identified and defined as contributors. Specific immune deficiencies that are closely associated with bronchiectasis and as discussed in this article are common variable immunodeficiency, specific antibody deficiency, immunodeficiencies involving immunoglobulin E, DOCK8 immunodeficiency, phosphoglucomutase 3 deficiency, activated phosphoinositide 3-kinase delta syndrome, and X-linked agammaglobulinemia. Each of these primary immune deficiencies has unique nuances. Vigilance for these unique signs and symptoms is likely to improve recognition of specific immunodeficiency in the idiopathic bronchiectasis patient. Secondary forms of immunodeficiency occur as a result of a separate disease process. Graft versus host disease, malignancy, and human immunodeficiency virus are three classic examples discussed in this article. An awareness of the potential for these disease settings to lead to bronchiectasis is necessary to optimize patient care. With understanding and mindfulness toward the intricate relationship between bronchiectasis and immunodeficiency, there is an opportunity to elucidate pathophysiologic underpinnings between these two syndromes.
Collapse
|
2
|
Jiang JH, Zhang CL, Wu QL, Liu YH, Wang XQ, Wang XL, Fang BM. Rapidly progressing primary pulmonary lymphoma masquerading as lung infectious disease: A case report and review of the literature. World J Clin Cases 2021; 9:4016-4023. [PMID: 34141761 PMCID: PMC8180211 DOI: 10.12998/wjcc.v9.i16.4016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary anaplastic large cell lymphoma of the lung represents a diagnostic challenge due to diverse manifestations and non-specific radiological findings, particularly in cases that lack extra-pulmonary manifestations and lung biopsy. CASE SUMMARY A 40-year-old woman presented with a 6-d history of fever, dry coughing, and dyspnea. Her white blood cell count was 20100/mm3 with 90% neutrophils. PaO2 was 60 mmHg and SaO2 was 90% when breathing ambient air. Chest computed tomography (CT) identified a solid nodule, 15 mm in diameter, with a poorly defined boundary in the upper right lung, and several smaller solid nodules throughout both lungs. Pulmonary artery CT and subsequent bedside X-ray showed diffuse patchy shadows throughout both lungs. Repeated cultures of blood samples and alveolar lavage failed to identify any pathogen. Due to the mismatch between clinical and imaging features, we conducted a bone marrow biopsy, and the results showed proliferation along all three lineages but no atypical or malignant cells. The patient received empirical antibacterial, antiviral, and antifungal treatments, as well as corticosteroids. The patient's condition deteriorated rapidly despite treatment. The patient died 6 d after hospitalization due to respiratory failure. Post-mortem lung biopsy failed to show inflammation but identified widespread infiltration of alveolar septum by anaplastic lymphoma kinase (ALK)-positive anaplastic cells. CONCLUSION ALK-positive anaplastic large cell lymphoma could present as a primary pulmonary disease without extra-pulmonary manifestations.
Collapse
Affiliation(s)
- Jin-Hong Jiang
- Department of Hematology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Chun-Lai Zhang
- Department of Ultrasonography, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Qin-Li Wu
- Department of Pathology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Yong-Hua Liu
- Department of Hematology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Xiao-Qiu Wang
- Department of Hematology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Xiao-Li Wang
- Department of Hematology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Bing-Mu Fang
- Department of Hematology, Lishui City People's Hospital, Lishui 323000, Zhejiang Province, China
| |
Collapse
|
3
|
Mainardi AS, Siddon AJ, Bader AS, Hilbert J. Progressive Dyspnea and Hypoxemia With Diffuse Pulmonary Infiltrates in a Previously Healthy Woman. Chest 2021; 158:e327-e334. [PMID: 33280778 DOI: 10.1016/j.chest.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022] Open
Abstract
CASE PRESENTATION A 50-year-old woman presented with 3 months of cough, dyspnea, and fatigue. She also reported new fevers, night sweats, and a rash on her face and torso. On presentation she was tachycardic and tachypneic, with oxygen saturation of 81% on 2 L/min of oxygen. She was in mild respiratory distress. Results of the physical examination were remarkable for tender left cervical and axillary adenopathy and bibasilar pulmonary crackles. She had an acneiform rash on her face, chest, and back, consisting of multiple nonblanching erythematous or violaceous macules and papules (Fig 1) and had conjunctival edema. Admission laboratory test results were significant for a WBC count of 56,000, of which 79.5% were lymphocytes. Hemoglobin and platelet levels were normal. She was admitted for further management.
Collapse
Affiliation(s)
- Anne S Mainardi
- Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT; Respiratory, Critical Care, and Sleep Medicine, University of Tennessee/Erlanger Health System, Chattanooga, TN.
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Anna S Bader
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Janet Hilbert
- Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
4
|
McDonald JP, Law NL, Haggstrom JA, Kruse MJ. T-cell lymphoma in a man with persistent dyspnea and unusual dependent pulmonary interstitial thickening. BMJ Case Rep 2021; 14:14/5/e241884. [PMID: 33972301 PMCID: PMC8112426 DOI: 10.1136/bcr-2021-241884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- James P McDonald
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Nathan L Law
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - John A Haggstrom
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Matthew J Kruse
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| |
Collapse
|
5
|
Uncommon thoracic manifestations from extrapulmonary tumors: Computed tomography evaluation - Pictorial review. Respir Med 2020; 168:105986. [PMID: 32469707 DOI: 10.1016/j.rmed.2020.105986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 11/23/2022]
Abstract
Although metastasis can occur at a variety of sites, pulmonary involvement is common in patients with cancer. Depending on the source and type of tumor, pulmonary metastases present with a wide range of radiologic appearances. Hematogenous dissemination through the pulmonary arteries to the pulmonary capillary network is the most common form of spread in pulmonary metastases. However, they may also reach the lung via lymphatic dissemination, secondary airway involvement, vessel tumor embolism, and direct chest invasion. In the evaluation of patients with known extrathoracic tumors, CT is the state-of-the-art imaging modality for detecting and characterize pulmonary metastases as well as to predict resectability. Although CT limitations are well known, knowledge of growth rates of various tumors and understanding the pattern of spread may be helpful clues in suggesting and even establish the specific diagnosis. The purpose of this pictorial review is to discuss the imaging appearances of different patterns of intrathoracic tumoral dissemination.
Collapse
|
6
|
Liu CY, Chen BJ, Chuang SS. Malignant effusions from extranodal NK/T-cell lymphomas are frequently of anaplastic morphology with azurophilic granules and of T-cell lineage. Diagn Cytopathol 2020; 48:453-463. [PMID: 32020785 DOI: 10.1002/dc.24388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) nasal type is an extranodal lymphoma, with most cases arising from the prototypic nasal/upper aerodigestive tract and the cell of origin (COO) is frequently of NK cells. Effusion involvement by ENKTL is rare. The cytomorphological and immunophenotypical features and COO of effusion ENKTL are elusive. DESIGN We report four new cases of effusion ENKTL, reviewing the cytomorphological features and investigating their COO by immunohistochemistry for T-cell receptor (TCR) protein expression and clonality assay for TCR gene rearrangement. We also reviewed 12 additional cases of effusion ENKTL from the literature. RESULTS All our four cases showed anaplastic tumor cells with fine to coarse azurophilic granules, with the primary tumor organs from the prototypic sites (2), small intestine (1), or indeterminate (1). The COO was either T-cell (3) or NK-cell (1). Compiling our four cases with that from the literature, all 16 effusion ENKTL cases were Epstein-Barr virus-associated and the majority (83%; 10/12) originated from the nonprototypic sites. Five of six (83%) effusion ENKTL cases were of T-cell lineage. Prognosis was poor with a median survival time of only 2.4 months. CONCLUSIONS Our study revealed that ENKTL in the effusion might be characterized by anaplastic large cell morphology, cytoplasmic azurophilic granules, and a higher proportion of T-cell lineage as compared to de novo tumors arising from the prototypic sites. ENKTL rarely presented in effusion, which is associated with dismal outcome. Large international studies are warranted to validate these findings.
Collapse
Affiliation(s)
- Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Bo-Jung Chen
- Department of Pathology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pathology, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Pathology, School of Medicine, National Taiwan University, Taipei, Taiwan
| | | |
Collapse
|
7
|
Gosangi B, Hatabu H, Hammer MM. Imaging Features of Pulmonary Leukemic Infiltration With Comparison of Lymphoid and Myeloid Leukemias. Curr Probl Diagn Radiol 2019; 50:164-167. [PMID: 31582265 DOI: 10.1067/j.cpradiol.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the imaging findings of lung infiltration by leukemia and differential findings of lymphoid and myeloid leukemias. MATERIALS AND METHODS Through a search of electronic medical records from 2005 to 2017, we identified 21 patients with pathologically proven lung involvement by leukemia. Concurrent CT findings were analyzed by 2 chest radiologists in consensus for ground glass or consolidative opacities, septal thickening, bronchovascular bundle thickening, pulmonary nodules, pulmonary masses, and hilar and mediastinal lymphadenopathy. RESULTS There were 13 cases of lymphoid leukemias and 8 of myeloid leukemias. Nodules and masses were the most common imaging feature (n = 13, 62%). Bronchovascular bundle thickening and hilar lymphadenopathy were exclusively seen in lymphoid leukemias (P = 0.01 and P = 0.006). Centrilobular nodules were also exclusively seen in 3 patients with chronic lymphocytic leukemia. CONCLUSION Lung infiltration by leukemia presents most commonly with nodules or masses, but interstitial abnormalities such as bronchovascular bundle thickening were seen as well. Radiologists should consider leukemic infiltration in the differential diagnosis for nodules, including centrilobular nodules, in these patients.
Collapse
Affiliation(s)
- Babina Gosangi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
8
|
Agrawal A, Sikachi RR, Koenig S, Khanijo S. A 68-Year-Old Man With Dyspnea on Exertion and Cough. Chest 2019; 153:e139-e145. [PMID: 29884276 DOI: 10.1016/j.chest.2018.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/27/2018] [Accepted: 02/19/2018] [Indexed: 11/26/2022] Open
Abstract
A 68-year-old man with a history of chronic lymphocytic leukemia well controlled on ibrutinib, hypertension, obesity, and a remote history of smoking (10 pack-years) presented with increasing dyspnea on exertion and cough. He had previously finished two courses of oral antibiotics for his symptoms without significant improvement. On presentation, he had no fevers or sputum production.
Collapse
Affiliation(s)
- Abhinav Agrawal
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, Northwell Health, New Hyde Park, NY.
| | - Rutuja R Sikachi
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, Northwell Health, New Hyde Park, NY
| | - Seth Koenig
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, Northwell Health, New Hyde Park, NY
| | - Sameer Khanijo
- Division of Pulmonary, Critical Care & Sleep Medicine, Hofstra Northwell School of Medicine, Northwell Health, New Hyde Park, NY
| |
Collapse
|
9
|
Acuna-Villaorduna A, Gonzalez-Lugo J, Ye BH, Adrianzen Herrera DA, Sica RA, Shah U, Shah N, Kornblum N, Braunschweig I, Derman O, Mantzaris I, Shastri A, Wang Y, Verma A, Zalta B, Janakiram M. High prevalence of pulmonary findings in computed tomographies of HTLV-1-infected patients with and without adult-T cell leukemia/lymphoma - implications for staging. Leuk Lymphoma 2019; 60:3272-3276. [PMID: 31204876 DOI: 10.1080/10428194.2019.1627543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lung involvement has been reported in HTLV-1 carriers and in patients with ATLL. Whether there are differences in the pattern of lung involvement between ATLL and HTLV carriers in North American patients is unknown. We aimed to compare CT pulmonary findings among patients with HTLV-1 infection with and without ATLL. Among 140 patients with HTLV-1 diagnosis, 97 had CT chest available. Of these, 72 (74.2%) had ATLL and 25 (25.8%) did not have ATLL. CT chest abnormalities were present in 90 (92.8%) participants (94.4% in ATLL; 88% in non-ATLL). Higher rates of lymphadenopathy (69.4% versus 24%, p < .01) and lower rates of bronchiectasis (25% versus 48%, p = .04) were seen in ATLL compared to non-ATLL. Our study supports that staging of lung involvement in ATLL should consider HTLV-associated pulmonary findings as not all CT chest abnormalities necessarily represent malignant infiltration.
Collapse
Affiliation(s)
| | | | - B Hilda Ye
- Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Urvi Shah
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nishi Shah
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Noah Kornblum
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Olga Derman
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Aditi Shastri
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - Amit Verma
- Department of Oncology, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | | | - Murali Janakiram
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
10
|
Yogi S, Yamashiro T, Kamiya H, Kamiya A, Miyara T, Moromizato H, Murayama S. Thoracic manifestations of adult T-cell leukemia/lymphoma on chest CT: difference between clinical subtypes. ACTA ACUST UNITED AC 2019; 25:55-61. [PMID: 30582570 DOI: 10.5152/dir.2018.18038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate thoracic computed tomography (CT) findings in adult T-cell leukemia/lymphoma (ATL) and their differences among clinical subtypes. METHODS Thoracic CT scans of 49 ATL patients were retrospectively reviewed. On CT scans, the presence of lung parenchymal abnormalities (10 patterns), enlarged lymph nodes, pleural and pericardial effusions, and subcutaneous nodules was evaluated by two radiologists in cooperation. According to the Shimoyama criteria, the patients were divided into aggressive ATL group (n=28, acute and lymphoma types) and indolent ATL group (n=21, chronic and smoldering types). Differences in the prevalence of the CT findings between the two groups were examined. In the indolent ATL group, CT scans of 10 patients who eventually underwent transformation to aggressive ATL were also evaluated. RESULTS In aggressive ATL, enlarged lymph nodes (68%) was the most frequently observed finding. Several patterns of lung abnormalities were observed, such as ground-glass attenuation (36%), bronchial wall thickening (32%), nodules (29%), and centrilobular opacities (29%). In indolent ATL, enlarged lymph nodules (24%) and bronchiectasis (24%) were relatively frequently detected. Overall, the incidence of abnormal findings was higher in aggressive than in indolent ATL, except for bronchiectasis. Patients with transformation to aggressive ATL frequently demonstrated enlarged lymph nodes (80%). CONCLUSION On thoracic CT, enlarged lymph nodes and various lung and airway abnormalities, such as ground-glass attenuation and bronchial wall thickening, were observed in ATL patients, particularly those with aggressive ATL. Bronchiectasis was similarly found in patients with indolent ATL and aggressive ATL.
Collapse
Affiliation(s)
- Satoko Yogi
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hisashi Kamiya
- Department of Radiology, Nakagami Hospital, Okinawa City, Okinawa, Japan
| | - Ayano Kamiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Tetsuhiro Miyara
- Nakagami Hospital, Okinawa City, Okinawa, Japan; Department of Radiology, Okinawa Red Cross Hospital, Naha, Okinawa, Japan
| | | | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| |
Collapse
|
11
|
Hutchison T, Malu A, Yapindi L, Bergeson R, Peck K, Romeo M, Harrod C, Pope J, Smitherman L, Gwinn W, Ratner L, Yates C, Harrod R. The TP53-Induced Glycolysis and Apoptosis Regulator mediates cooperation between HTLV-1 p30 II and the retroviral oncoproteins Tax and HBZ and is highly expressed in an in vivo xenograft model of HTLV-1-induced lymphoma. Virology 2018; 520:39-58. [PMID: 29777913 DOI: 10.1016/j.virol.2018.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 12/28/2022]
Abstract
The human T-cell leukemia virus type-1 (HTLV-1) is an oncoretrovirus that infects and transforms CD4+ T-cells and causes adult T-cell leukemia/lymphoma (ATLL) -an aggressive lymphoproliferative disease that is highly refractive to most anticancer therapies. The HTLV-1 proviral genome encodes several regulatory products within a conserved 3' nucleotide sequence, known as pX; however, it remains unclear how these factors might cooperate or dynamically interact in virus-infected cells. Here we demonstrate that the HTLV-1 latency-maintenance factor p30II induces the TP53-induced glycolysis and apoptosis regulator (TIGAR) and counters the oxidative stress, mitochondrial damage, and cytotoxicity caused by the viral oncoproteins Tax and HBZ. The p30II protein cooperates with Tax and HBZ and enhances their oncogenic potential in colony transformation/foci-formation assays. Further, we have shown that TIGAR is highly expressed in HTLV-1-induced tumors associated with oncogene dysregulation and increased angiogenesis in an in vivo xenograft model of HTLV-1-induced T-cell lymphoma. These findings provide the first evidence that p30II likely collaborates as an ancillary factor for the major oncoproteins Tax and HBZ during retroviral carcinogenesis.
Collapse
Affiliation(s)
- Tetiana Hutchison
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Aditi Malu
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Laçin Yapindi
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Rachel Bergeson
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Kendra Peck
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Megan Romeo
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Carolyn Harrod
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Jordan Pope
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Louisa Smitherman
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Wesleigh Gwinn
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States
| | - Lee Ratner
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Courtney Yates
- Laboratory Animal Resource Center, Southern Methodist University, Dallas, TX 75275, United States
| | - Robert Harrod
- Laboratory of Molecular Virology, Department of Biological Sciences, and The Dedman College Center for Drug Discovery, Design & Delivery, Southern Methodist University, 6501 Airline Drive, 334-DLS, Dallas, TX 75275-0376, United States.
| |
Collapse
|
12
|
Licata MJ, Janakiram M, Tan S, Fang Y, Shah UA, Verma AK, Wang Y. Diagnostic challenges of adult T-cell leukemia/lymphoma in North America - a clinical, histological, and immunophenotypic correlation with a workflow proposal. Leuk Lymphoma 2017; 59:1188-1194. [PMID: 29504866 DOI: 10.1080/10428194.2017.1365862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Adult T-cell leukemia-lymphoma (ATLL) is caused by human T-cell lymphotropic virus type 1 (HTLV-1) and little is known about ATLL endemic to the Caribbean basin and Latin America, designated as western ATLL (W-ATLL). Due to extensive systemic involvement and nonspecific clinical presentation, the initial diagnosis in this cohort can be very challenging. We have diagnosed 60 patients with W-ATLL over a 14-year period. ATLL involves the peripheral blood, bone marrow, and cerebrospinal fluid (CSF) in 98, 87, and 52% cases, respectively; while lymphadenopathy, pulmonary infiltrates, splenomegaly, and hepatomegaly was present in 90, 82, 48, and 45% patients, respectively. While 87% patients developed hypercalcemia only 28% had lytic bone lesions. We propose that any diagnosis of a peripheral T-lymphoproliferative disorder should result in a comprehensive review of the patient's endemic, laboratory information, HTLV-1 testing for proper diagnosis, and identification due to the varied manifestations of this disease.
Collapse
Affiliation(s)
- Michael J Licata
- a Department of Pathology , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Murali Janakiram
- b Department of Oncology , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Stephanie Tan
- c Department of Radiology , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Yanan Fang
- a Department of Pathology , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Urvi A Shah
- b Department of Oncology , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Amit K Verma
- b Department of Oncology , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| | - Yanhua Wang
- a Department of Pathology , Albert Einstein College of Medicine/Montefiore Medical Center , Bronx , NY , USA
| |
Collapse
|
13
|
Bashoura L, Eapen GA, Faiz SA. Pulmonary Manifestations of Lymphoma and Leukemia. Clin Chest Med 2017; 38:187-200. [DOI: 10.1016/j.ccm.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
14
|
Follicular Lymphoma Diagnosed With Medical Thoracoscopy. J Bronchology Interv Pulmonol 2016; 23:79-82. [PMID: 26496088 DOI: 10.1097/lbr.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Non-Hodgkin lymphomas may present with a recurrent pleural effusion, usually with involvement of other thoracic or extrathoracic sites. Lymphomas typically presenting with pleural disease include primary effusion lymphoma and pyothorax-associated lymphoma. We describe an unusual case of recurrent pleural effusion secondary to follicular lymphoma with no other known extrathoracic involvement at the time of diagnosis.
Collapse
|
15
|
Feng Y, Zhao J, Yang Q, Xiong W, Zhen G, Xu Y, Zhang Z, Zhang H. Pulmonary melanoma and "crazy paving" patterns in chest images: a case report and literature review. BMC Cancer 2016; 16:592. [PMID: 27488496 PMCID: PMC4973081 DOI: 10.1186/s12885-016-2630-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
Background In the lung, melanoma is mostly arranged as patterns of multiple nodules, solitary nodules, or miliary invasions. Very rarely, it also displays a “crazy paving” pattern (also described as a “paving stone,” “flagstone,” or “slabstone” pattern), which is rarer still in discrete bilateral nodules. This pattern is considered to be caused by pulmonary alveolar proteinosis, but its association with various diseases is unclear. Case presentation A 60-year-old man was diagnosed with pulmonary melanoma. Computed tomography revealed discrete bilateral nodules surrounded by a “paving” pattern. A literature review found more than 40 types of diseases that have presented with “paving” patterns in the lung—predominantly pulmonary alveolar proteinosis, viral pneumonia, exogenous lipoid pneumonia, bacterial pneumonia, pulmonary alveolar microlithiasis, interstitial pneumonia, ARDS, squalene aspiration pneumonia, radiation pneumonitis, drug-induced pneumonitis, pulmonary leptospirosis, pulmonary hemorrhage, and pulmonary nocardiosis. Conclusions We describe the first case of pulmonary melanoma in the form of discrete bilateral nodules accompanied with a computed tomography paving pattern. Although pulmonary paving patterns are rare, more than 40 diseases reportedly display them; clinicians should consider melanoma of the lung in differential diagnoses for patients who show such a pattern.
Collapse
Affiliation(s)
- Yikuan Feng
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jianping Zhao
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qun Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guohua Zhen
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yongjian Xu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhenxiang Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huilan Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
16
|
Qin J, Liu J, Axiotis CA. Cytological diagnosis of adult T-cell leukemia/lymphoma in sputum. Diagn Cytopathol 2016; 44:416-8. [PMID: 26972585 DOI: 10.1002/dc.23431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 12/02/2015] [Accepted: 12/18/2015] [Indexed: 11/07/2022]
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a rare and often aggressive T-cell leukemia/lymphoma that has been linked to infection by the human T-cell lymphotropic virus type 1 (HTLV-1). ATLL can involve multiple organs including the respiratory airway. A 53-year-old Trinidadian woman presented with productive cough and progressive shortness of breath. Her past medical history included duodenal strongyloidosis, skin rash, and hypercalcemia. Radiological studies showed increased interstitial markings. Sputum cytology showed atypical pleomorphic, small-to-medium-sized, lobated lymphocytes with irregular and hyperchromatic nuclei resembling "flower cells" which were CD3±/CD20- by immunocytochemistry. A lung biopsy showed interstitial, peribronchiolar, and subpleural infiltration by a CD3±/CD25± atypical lymphocytic infiltrate. Together with peripheral blood findings and positive HTLV-1 serology, the diagnosis of ATLL was made. We suggest that sputum evaluation in patients with ATLL risk factors can be diagnostic.
Collapse
Affiliation(s)
- Jia Qin
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Jinli Liu
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York.,Kings County Hospital Center, Brooklyn, New York
| | - Constantine A Axiotis
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York.,Kings County Hospital Center, Brooklyn, New York
| |
Collapse
|
17
|
Cha MJ, Lee KS, Hwang HS, Kim TJ, Kim TS, Kim BT, Ko YH, Shim YM. Pulmonary Intravascular Lymphomatosis: Clinical, CT, and PET Findings, Correlation of CT and Pathologic Results, and Survival Outcome. Radiology 2016; 280:602-10. [PMID: 26943231 DOI: 10.1148/radiol.2016151706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To describe clinical, computed tomographic (CT), and positron emission tomographic (PET) features, correlation of CT and pathologic results, and survival of patients with pulmonary intravascular lymphomatosis. Materials and Methods The institutional review board approved this retrospective study with waiver of patient consent. Forty-two patients with pulmonary intravascular lymphomatosis were identified, 11 (26%) of whom showed lung involvement. CT features were correlated with histopathologic results. Clinical and survival outcomes were compared between patients with and those without pulmonary involvement by adopting the χ(2), Student t, or Kaplan-Meier analysis with log-rank tests. Results At clinical presentation, all 11 patients showed B symptoms (systemic symptoms of fever, night sweats, and weight loss), 10 had respiratory and four had neurologic symptoms, and two had skin lesions. Patients received cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with (n = 5) or without (n = 6) rituximab, and seven (64%) patients died. Patients with lung involvement showed reduced overall and recurrence-free survival (median; 10.8 and 18.9 months, respectively) compared with those without lung involvement (median, 18.4 and 31.0 months, respectively) (P = .338 and .065, respectively). The most common CT abnormality was bilateral ground-glass opacity (GGO, n = 10), with increased fluorodeoxyglucose uptake at PET/CT (seven of seven patients). GGO correlated histopathologically with the expanded alveolar septal vasculatures and perivascular spaces filled with neoplastic lymphoid cells. Conclusion Pulmonary intravascular lymphomatosis appeared as bilateral GGO on CT images, with increased fluorodeoxyglucose uptake on PET/CT images. GGO on CT images correlated with the area of expanded alveolar septae because of distended vessels filled with neoplastic lymphoid cells. (©) RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Min Jae Cha
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Kyung Soo Lee
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Hye Sun Hwang
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Tae Jung Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Tae Sung Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Byung-Tae Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Young-Hyeh Ko
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Young Mog Shim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| |
Collapse
|
18
|
Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Hematologic neoplasms: Interpreting lung findings in chest computed tomography. RADIOLOGIA 2015. [PMCID: PMC7153726 DOI: 10.1016/j.rxeng.2015.09.001] [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] [Indexed: 11/21/2022]
Abstract
Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients.
Collapse
|
19
|
Birckhead BJ, Peterson JL, Patel AB, Miller RC. Palliative Radiation for Leukemic Arthropathy from Human T-Cell Lymphoma Virus-associated Adult T-Cell Leukemia Lymphoma. Rare Tumors 2015; 7:5834. [PMID: 26500728 PMCID: PMC4600990 DOI: 10.4081/rt.2015.5834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 11/23/2022] Open
Abstract
Human T-cell lymphoma virus (HTLV)-associated adult T-cell leukemia lymphoma is a rare cancer in the United States, but there are several areas around the world where the virus is endemic. HTLV-associated adult T-cell leukemia lymphoma has been associated with leukemic arthropathy. We present a patient with HTLV-associated adult T-cell leukemia lymphoma with leukemic arthropathy. Although non-steroidal anti-inflammatory drugs and chemotherapy are often used for treatment, we describe the successful use of radiation therapy in the palliative relief of symptoms from leukemic arthropathy.
Collapse
Affiliation(s)
| | | | - Ajay B Patel
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
| |
Collapse
|
20
|
Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Hematologic neoplasms: interpreting lung findings in chest computed tomography. RADIOLOGIA 2015; 57:455-70. [PMID: 26315258 PMCID: PMC7127573 DOI: 10.1016/j.rx.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/26/2015] [Accepted: 07/04/2015] [Indexed: 12/21/2022]
Abstract
La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos.
Collapse
Affiliation(s)
- P Calvillo Batllés
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España.
| | - J Carreres Polo
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - J Sanz Caballer
- Servicio de Hematología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - M Salavert Lletí
- Unidad de Enfermedades Infecciosas, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - L Compte Torrero
- Servicio de Neumología, Hospital Politècnic i Universitari La Fe, Valencia, España
| |
Collapse
|
21
|
Escuissato DL, Warszawiak D, Marchiori E. Differential diagnosis of diffuse alveolar haemorrhage in immunocompromised patients. Curr Opin Infect Dis 2015; 28:337-42. [DOI: 10.1097/qco.0000000000000181] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
22
|
Okada F, Sato H, Omeri AK, Ono A, Tokuyama K, Ando Y, Matsumoto A, Ogata M, Kohno K, Takano K, Mori H. Chest HRCT findings in acute transformation of adult T-cell lymphoma/leukemia. Eur Radiol 2015; 25:1607-13. [PMID: 25576228 DOI: 10.1007/s00330-014-3565-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/24/2014] [Accepted: 12/11/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess chest high-resolution computed tomography (HRCT) findings in patients with acute transformation of adult T cell leukaemia/lymphoma (ATLL). METHODS We retrospectively identified 72 consecutive patients at our institution with ATLL between October 2000 and March 2014. The cases included acute type (n = 20), lymphoma type (n = 21), smouldering type (n = 24) and chronic type (n = 7). Sixteen (7 men, 9 women; aged 36-85 years, mean 63.3 years) of 31 patients (24 with smouldering and seven with chronic type; 51.6 %) developed acute transformation of ATLL, and had undergone chest HRCT examinations. Parenchymal abnormalities, enlarged lymph nodes, pericardial effusion, pleural effusion and skin lesions were evaluated on HRCT. RESULTS Chest HRCT of 15 of the 16 patients showed abnormal findings, including ground-glass opacity (GGO) (n = 8), consolidation (n = 5), interlobular septal thickening (n = 5) and nodules (n = 5). Pleural effusion was found in five patients, lymph node enlargement in 10 patients and multiple skin thickening in two patients. CONCLUSIONS Almost all patients with acute transformation of ATLL had abnormal findings on chest HRCT, which consisted mainly of lymph node enlargement, GGO, interlobular septal thickening, nodules and bilateral pleural effusions. KEY POINTS • The recognition of CT findings of acute transformation is important • Almost all patients with acute transformation have abnormal findings on HRCT • Characteristic CT features are present in acute transformation of indolent ATLL.
Collapse
Affiliation(s)
- Fumito Okada
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Adult T-cell leukemia/lymphoma is a rare mature CD4+ T-cell neoplasm caused by the retrovirus human T-lymphotrophic virus type 1. At present there are approximately 20 million people infected globally with this virus, and most of these individuals belong to the endemic areas in southern Japan, Africa, the Caribbean basin, and Latin America. In the United States, it is usually seen in immigrants from these endemic regions. Adult T-cell leukemia/lymphoma predominantly affects the adult population and is rare in children. Adult T-cell leukemia/lymphoma has 4 subtypes: acute, lymphomatous, chronic, and smoldering. Clinically, the first 2 variants are classified as aggressive, and the latter two are classified as indolent. Given the rare occurrence and diagnostic challenges associated with adult T-cell leukemia/lymphoma, this review will highlight its salient features to aid in recognition of this entity and perform a comprehensive diagnostic workup.
Collapse
Affiliation(s)
- Sohail Qayyum
- From the Department of Pathology, University of Tennessee Health Science Center, Memphis (Dr Qayyum); and the Department of Hematopathology, St Jude Children's Research Hospital, Memphis, Tennessee (Dr Choi)
| | - John K. Choi
- From the Department of Pathology, University of Tennessee Health Science Center, Memphis (Dr Qayyum); and the Department of Hematopathology, St Jude Children's Research Hospital, Memphis, Tennessee (Dr Choi)
| |
Collapse
|
24
|
Ohnishi H, Yamane T, Shiota N, Yokoyama A. Life-threatening pulmonary lymphedema secondary to thoracic duct ligation. Intern Med 2014; 53:2341-5. [PMID: 25318800 DOI: 10.2169/internalmedicine.53.2822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report an extremely rare adult case presenting with life-threatening pulmonary lymphedema secondary to generalized lymphedema. A 47-year-old woman with generalized lymphedema from her feet to below her chest, had undergone surgical ligation of the thoracic duct and bilateral pleurodesis for the treatment of intractable idiopathic chylothorax three years earlier. Chest computed tomography demonstrated bilateral ground-glass opacities, air-space consolidation and interlobular septal wall thickening, presenting as a crazy-paving appearance predominantly on the gravity side. Bronchoalveolar lavage revealed marked lymphocytosis. She was treated with long-term oxygen therapy with noninvasive positive-pressure ventilation, followed by lymphovenous anastomoses of the lower extremities.
Collapse
Affiliation(s)
- Hiroshi Ohnishi
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Japan
| | | | | | | |
Collapse
|
25
|
Restrepo CS, Carrillo J, Rosado de Christenson M, Ojeda Leon P, Lucia Rivera A, Koss MN. Lymphoproliferative Lung Disorders: A Radiologic-Pathologic Overview. Part II: Neoplastic Disorders. Semin Ultrasound CT MR 2013; 34:535-49. [DOI: 10.1053/j.sult.2013.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
26
|
William J, Variakojis D, Yeldandi A, Raparia K. Lymphoproliferative neoplasms of the lung: a review. Arch Pathol Lab Med 2013; 137:382-91. [PMID: 23451749 DOI: 10.5858/arpa.2012-0202-ra] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Diagnosis and classification of lymphomas are based on the morphologic, immunologic, and genetic features that the lesional cells share with their normal B and T lymphocyte counterparts. Primary pulmonary lymphomas account for 0.3% of primary lung neoplasms and less than 0.5% of all lymphomas. OBJECTIVE To describe and summarize the clinical and histopathologic features of the primary pulmonary lymphoma and secondary involvement of the lung by lymphoma. DATA SOURCES Peer-reviewed published literature and personal experience. CONCLUSIONS Diagnosis of clonal lymphoid proliferations in the lung has evolved owing to the greater utility of molecular and flow cytometric analysis of tissue. Further studies are needed to best define the clinical and prognostic features, as well as search for targeted therapy for these patients with rare neoplasms.
Collapse
Affiliation(s)
- Josette William
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | | |
Collapse
|
27
|
Bommart S, Bourdin A, Makinson A, Durand G, Micheau A, Monnin-Bares V, Klein F, Kovacsik H. Infectious chest complications in haematological malignancies. Diagn Interv Imaging 2013; 94:193-201. [DOI: 10.1016/j.diii.2012.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
28
|
Hanaka M, Yatera K, Itoh C, Kawanami T, Nakanishi T, Katsuragi T, Shimajiri S, Ishimoto H, Tsukada J, Mukae H. Case of adult T-cell leukemia/lymphoma with rapid progression of pulmonary areas of ground-glass attenuation and multiple nodules. Respir Investig 2013; 51:40-5. [PMID: 23561258 DOI: 10.1016/j.resinv.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 10/04/2012] [Accepted: 10/10/2012] [Indexed: 11/19/2022]
Abstract
We report a case of adult T-cell leukemia/lymphoma (ATL) with rapidly progressive pulmonary areas of ground-glass attenuation (GGA) and nodules resulting from acute transformation of chronic ATL. A 48-year-old Japanese man was admitted for progressive dyspnea. Chest computed tomography showed rapidly progressive bilateral pulmonary areas of GGA and nodules. Flow cytometry of bronchoalveolar lavage fluid and immunohistochemical examination of lung biopsy specimens revealed invasion of ATL cells. Systemic chemotherapy improved the pulmonary findings. Rapidly expanding areas of GGA and nodules are a rare manifestation of pulmonary invasion of ATL that clinicians should nevertheless keep in mind.
Collapse
Affiliation(s)
- Minako Hanaka
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu City, Fukuoka 807-8555, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Truong T. The overlap of bronchiectasis and immunodeficiency with asthma. Immunol Allergy Clin North Am 2012; 33:61-78. [PMID: 23337065 DOI: 10.1016/j.iac.2012.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bronchiectasis should be considered as a differential diagnosis for, as well as a comorbidity in, patients with asthma, especially severe or long-standing asthma. Chronic airway inflammation is thought to be the primary cause, as with chronic or recurrent pulmonary infection and autoimmune conditions that involve the airways. Consequently, immunodeficiencies with associated increased susceptibility to respiratory tract infections or chronic inflammatory airways also increase the risk of developing bronchiectasis. Chronic bronchiectasis is associated with impaired mucociliary clearance and increased bronchial secretions, leading to airway obstruction and airflow limitation, which can lead to exacerbation of underlying asthma or increased asthma symptoms.
Collapse
Affiliation(s)
- Tho Truong
- Allergy and Clinical Immunology, National Jewish Health, Denver, CO, USA.
| |
Collapse
|
30
|
Ochs RC, Bagg A. Molecular genetic characterization of lymphoma: Application to cytology diagnosis. Diagn Cytopathol 2012; 40:542-55. [DOI: 10.1002/dc.22819] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
31
|
Restrepo CS, Chen MM, Martinez-Jimenez S, Carrillo J, Restrepo C. Chest neoplasms with infectious etiologies. World J Radiol 2011; 3:279-88. [PMID: 22224176 PMCID: PMC3251813 DOI: 10.4329/wjr.v3.i12.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/19/2011] [Accepted: 10/11/2011] [Indexed: 02/06/2023] Open
Abstract
A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi’s sarcoma, Castleman’s disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.
Collapse
|
32
|
The crazy-paving pattern: a radiological-pathological correlation. Insights Imaging 2011; 2:117-132. [PMID: 22347941 PMCID: PMC3259383 DOI: 10.1007/s13244-010-0060-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 11/08/2010] [Accepted: 12/16/2010] [Indexed: 02/06/2023] Open
Abstract
The crazy-paving pattern is a linear pattern superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. The crazy-paving pattern is initially described as the pathognomonic sign of alveolar proteinosis. Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. The purpose of this paper is to illustrate different diseases that cause this crazy-paving pattern and to correlate the radiological findings from computed tomography with the histopathological findings.
Collapse
|
33
|
Otsuka K, Kuronuma K, Otsuka M, Kitada J, Narita Y, Homma H, Miyajima S, Kitamura Y, Suzuki Y, Natsuizaka M, Yasui H, Ikeda H, Hayashi T, Ishida T, Shinomura Y, Noguchi H, Takahashi H. A case of adult T cell leukemia/lymphoma presenting as severe tracheal stenosis. Intern Med 2011; 50:2637-41. [PMID: 22041372 DOI: 10.2169/internalmedicine.50.5930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 57-year-old woman was referred to our hospital for further examination of a tracheal stenosis shown on computed tomography findings. Bronchoscopy revealed multiple protruding tumors in the lumen of the trachea. Cytological findings of the cell block material from pleural effusion indicated that the T-cell lymphoma was composed of pleomorphic lymphoid cells. Serum human T-cell leukemia virus type 1 antibody was positive and supported the clinical diagnosis of ATLL. Systemic chemotherapy induced the remarkable improvement of the lesions, the infiltrative lung shadow and the soft tissue neoplasm. We report a rare case of adult T cell leukemia/lymphoma (ATLL) with endobronchial involvement.
Collapse
Affiliation(s)
- Kengo Otsuka
- The Third Department of Internal Medicine, Sapporo Medical University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Uzunhan Y, Cadranel J, Boissel N, Gardin C, Arnulf B, Bergeron A. Les manifestations pulmonaires spécifiques des hémopathies myéloïdes aiguës et des hémopathies lymphoïdes et lymphoplasmocytaires. Partie II : les manifestations pulmonaires spécifiques des hémopathies lymphoïdes et lymphoplasmocytaires (hors lymphomes). Rev Mal Respir 2010; 27:599-610. [DOI: 10.1016/j.rmr.2010.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/16/2010] [Indexed: 12/12/2022]
|
35
|
Primary Pulmonary T-Cell Lymphoma in a Human T-Lymphotropic Virus Type-1 Carrier Showing Atypical Shadow. J Thorac Oncol 2010; 5:558-9. [DOI: 10.1097/jto.0b013e3181d3cccb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Localized ground glass opacities with multiple pulmonary small cysts in adult T-cell leukemia or lymphoma: an "alloy wheel" appearance. J Thorac Imaging 2010; 24:321-4. [PMID: 19935228 DOI: 10.1097/rti.0b013e3181c2f23d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We herein report a case of adult T-cell leukemia or lymphoma showing multiple lung cysts within a localized ground glass opacity (GGO) on computed tomography scan. The patterns of multiple localized GGOs having multiple small cysts were varied, including a large air space in the center of the localized GGO with surrounding small cysts, a solid part in the center of the localized GGO with peripheral small cysts, and clustered small cysts. These findings were considered to simulate the appearance of an "alloy wheel." Some of the central large air spaces had thickened walls. On the basis of the histopathologic findings, the pathogenesis of multiple cyst formation was considered to be a combination of 2 main mechanisms as follows: a check valve mechanism due to stenosis or an obstruction by the tumor cells' infiltration along the bronchioles, traction bronchiolectasis and ectatic alveoli by fibrosis.
Collapse
|
37
|
Shin CH, Paik SH, Park JS, Kim HK, Park SI, Cha JG, Koh ES. Primary pulmonary T-cell lymphoma: a case report. Korean J Radiol 2010; 11:234-8. [PMID: 20191072 PMCID: PMC2827788 DOI: 10.3348/kjr.2010.11.2.234] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 09/03/2009] [Indexed: 12/03/2022] Open
Abstract
Primary pulmonary T-cell lymphoma is an extremely rare malady, and we diagnosed this in a 52-year-old male who was admitted to our hospital with cough for the previous two weeks. The chest CT demonstrated multiple variable sized mass-like consolidations with low density central necrosis in the peripheral portion of both the upper and lower lobes. Positron emission tomography (PET) showed multiple areas of hypermetabolic fluorodeoxyglucose (FDG) uptake in both lungs with central metabolic defects, which correlated with central necrosis seen on CT. The histological sample showed peripheral T-cell lymphoma of the not otherwise specified form. The follow-up CT scan showed an increased extent of the multifocal consolidative lesions despite that the patient had undergone chemotherapy.
Collapse
Affiliation(s)
- Chung Hee Shin
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do 420-767, Korea
| | | | | | | | | | | | | |
Collapse
|
38
|
Ishii H, Kawabata Y, Amemiya Y, Ogata M, Kadota JI. Multiple tiny granulomatous lesions with eosinophils in a patient with smoldering-type adult T-cell leukaemia: the possibility of a new type of bronchioloalveolopathy. Respirology 2009; 15:182-4. [PMID: 19895390 DOI: 10.1111/j.1440-1843.2009.01646.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We herein describe the first case, to our knowledge, of pulmonary lesions characterized by necrotizing granuloma formation with eosinophils, in a patient with smoldering-type adult T-cell leukaemia. A 74-year-old man, diagnosed with smoldering-type adult T-cell leukaemia 1 year previously, was admitted due to repeated pyrexia and concurrent identification of diffuse small pulmonary nodules. A surgical lung biopsy specimen revealed inflammatory nodular lesions measuring up to 3 mm in size, which contained necrotizing and non-necrotizing granulomas, intraluminar organization and eosinophils, and were of unknown aetiology. The patient's condition, including the radiological findings, improved gradually without any treatment. This case suggests the possibility of a new type of human T-lymphotropic virus type-1 associated bronchioloalveolar disorder.
Collapse
Affiliation(s)
- Hiroshi Ishii
- Department of Respiratory Medicine, Oita University Hospital, Oita 879-5593, Japan.
| | | | | | | | | |
Collapse
|
39
|
Kawel N, Schorer GM, Desbiolles L, Seifert B, Marincek B, Boehm T. Discrimination between invasive pulmonary aspergillosis and pulmonary lymphoma using CT. Eur J Radiol 2009; 77:417-25. [PMID: 19804951 DOI: 10.1016/j.ejrad.2009.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 09/13/2009] [Accepted: 09/17/2009] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose was to assess the characteristic CT features of invasive pulmonary aspergillosis (IPA) and pulmonary lymphoma (PL) and to analyze the potential to distinguish the two entities using CT. METHODS The CT images of 70 patients with either proven IPA (n = 35) or PL (n = 35) were evaluated retrospectively and independently by two radiologists (reader 1 [R1] and reader 2 [R2]), analyzing images for presence, number and characteristics of pulmonary nodules and masses, ground-glass opacities, consolidations and other interstitial changes. RESULTS Interreader agreement was moderate (4/33 CT features), good (9/33) or excellent (20/33). Pulmonary nodules (P = 0.045 [R1], P = 0.001 [R2]), nodules with spiculated outer contours (P < 0.001 [R1], P = 0.001 [R2]), nodules with a halo sign (P < 0.001 [R1 + R2]), nodules with homogeneous (P = 0.030 [R1], P = 0.006 [R2]) and inhomogeneous (P = 0.001 [R1], P < 0.001 [R2]) attenuation patterns, nodules with cavitation (P = 0.006 [R1], P = 0.003 [R2]) and wedge-shaped, pleural-based consolidations (P < 0.001 [R1 + R2]) occurred significantly more often in patients with IPA, while masses without a halo sign (P = 0.03 [R1], P = 0.01 [R2]), lobar consolidations with bronchogram (P = 0.02 [R1 + R2]) and consolidations with homogeneous attenuation patterns (P < 0.001 [R1 + R2]) were found significantly more frequent in PL-patients. CONCLUSIONS Those CT features can therefore be considered suggestive for either IPA or PL. However, in most cases the diagnosis cannot be made based on CT findings solely because no single feature gained a high sensitivity and specificity concomitantly. Furthermore, the logistic regression did not show a combination that was significantly better than the best univariate predictor.
Collapse
Affiliation(s)
- Nadine Kawel
- Department of Radiology, Kantonsspital Graubuenden, Loestr 170, 7000 Chur, Switzerland.
| | | | | | | | | | | |
Collapse
|
40
|
Chang MH, Kim SJ, Kim K, Oh SY, Lee DH, Huh J, Ko YH, Choi CW, Yang DH, Won JH, Kim WS, Suh C. Clinical features and treatment outcomes of adult B- and T-lymphoblastic lymphoma: results of multicentre analysis in Korea. Leuk Lymphoma 2009; 50:1119-25. [PMID: 19557632 DOI: 10.1080/10428190902926999] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We performed a retrospective multicentre analysis to study the clinical features and treatment outcomes of B-lymphoblastic lymphoma (B-LBL) and T-lymphoblastic lymphoma (T-LBL) in Asian adult patients, and identify risk factors that predict relapse and poor prognosis. Fifty-five newly diagnosed patients (45 T-LBL and 10 B-LBL) were analysed. All patients were treated with intensive chemotherapy regimens including VPDL (vincristine, prednisolone, daunorubicin, L-asparaginase), CALGB (Cancer and leukemia group B), and Stanford/Northern California Oncology Group (NCOG). There was no difference of clinical features between B- and T-LBL except the frequent site of involvement. The overall response rate including complete response (28/55, 50.9%) and partial response (18/55, 32.7%) was 83.6%. Among 46 responders, 22 patients relapsed leading to 20 deaths. Partial responders showed more frequent relapse (10/18, 55.6%) than complete responders (11/28, 39.2%). The median progression-free survival (PFS) was 17 months (95% confidence interval, 11.5-22.5), and the 2-year overall survival was 52 +/- 7% with a median follow-up of 50 months (range 8-152). Treatment outcome of T-LBL and B-LBL was not significantly different in terms of response and survival. The presence of pleural effusion was significantly prognostic for overall and PFS (p < 0.05). In conclusion, clinical features and treatment outcome of Asian adult LBL were comparable to previous results, and the prognosis is still poor despite intensive chemotherapy.
Collapse
Affiliation(s)
- Myung Hee Chang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Nakayama S, Yokote T, Kobayashi K, Akioka T, Hara S, Miyoshi T, Hirata Y, Takubo T, Tsuji M, Hanafusa T. Pleural effusion infiltrated with peripheral T cell lymphoma, unspecified. Ann Hematol 2009; 88:817-8. [PMID: 19139890 DOI: 10.1007/s00277-008-0689-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 12/22/2008] [Indexed: 11/26/2022]
|
42
|
Rasul KI, Abbas MT, Binali AS, Murad N. Adult T-cell Leukemia/Lymphoma: First case report from Qatar. Qatar Med J 2008. [DOI: 10.5339/qmj.2008.1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In what appears to be the first case of Adult T-cell Leukemia|Lymphoma (ATLL) reported in Qatar and Middle Eastern Arab countries, a 39-year-old lady presented first with Pneumocystis carinii pneumonia and hypercalcaemia and later showed the full picture of ATLL, splenomegaly leukocytosis, skin rash, and bone marrow infiltrations. She responded well to chemotherapy, with complete remission after four cycles of combination chemotherapy but the prognosis of patients with ATLL is poor. Although patients may respond initially to treatment with combination chemotherapy regimens devised for advanced, aggressive Non-Hodgkin's Lymphoma (NHL), relapses are common with a median survival of eight months and a four-year survival of 12 percent.
Collapse
Affiliation(s)
- K. I. Rasul
- *Hematology/Oncology Department, Al Amal Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M. T. Abbas
- **Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - A. S. Binali
- **Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - N. Murad
- **Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
43
|
OYAMA K, KANEKURA T, YOSHII N, YONEKURA K, MERA K, HIRAYAMA Y, UMEKITA Y, YOSHIDA H, UMEMURA Y, KANZAKI T. Case of adult T-cell leukemia with pulmonary involvement presenting as nodular shadows. J Dermatol 2008; 35:225-8. [DOI: 10.1111/j.1346-8138.2008.00449.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
High-resolution Computed Tomography Findings of Diffuse Pulmonary Involvement by Mycosis Fungoides. J Thorac Imaging 2007; 22:366-8. [DOI: 10.1097/rti.0b013e3180592af8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Sverzellati N, Poletti V, Chilosi M, Casoni G, Hansell D, Zompatori AM. The crazy-paving pattern in granulomatous mycosis fungoides: high-resolution computed tomography-pathological correlation. J Comput Assist Tomogr 2006; 30:843-5. [PMID: 16954940 DOI: 10.1097/01.rct.0000214269.72180.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of this report is to describe a further distinctive cause of crazy-paving pattern on thin-section computed tomography in a patient affected by pulmonary granulomatous mycosis fungoides. It was possible to reconcile the crazy-paving appearance on thin-section computed tomography scan with the histopathologic pattern termed acute fibrinous organizing pneumonia pattern.
Collapse
Affiliation(s)
- Nicola Sverzellati
- Department of Clinical Sciences, Section of Radiology, University of Parma, Italy.
| | | | | | | | | | | |
Collapse
|
46
|
Okada F, Ando Y, Yoshitake S, Yotsumoto S, Matsumoto S, Wakisaka M, Maeda T, Mori H. Pulmonary CT Findings in 320 Carriers of Human T-Lymphotropic Virus Type 1. Radiology 2006; 240:559-64. [PMID: 16864677 DOI: 10.1148/radiol.2402050886] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate pulmonary computed tomographic (CT) findings in human T-lymphotropic virus type 1 (HTLV-1) carriers, who were characterized by means of polyclonal integration of proviral DNA. MATERIALS AND METHODS Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1996 and October 2004 in 320 (154 men, 166 women; age range, 31-86 years; mean, 64 years) patients with HTLV-1 were retrospectively evaluated by three chest radiologists. Parenchymal abnormalities (ground-glass opacity, consolidation, centrilobular nodules, thickening of bronchovascular bundles, interlobular septal thickening, and bronchiectasis) were evaluated, along with enlarged lymph nodes and pleural effusion. In 58 patients who underwent surgical biopsy or transbronchial biopsy, comparison of CT images with the actual specimens was performed by a pathologist and three chest radiologists. RESULTS On CT scans, abnormal findings were seen in 98 (30.1%) patients and consisted of centrilobular nodules (n = 95), thickening of bronchovascular bundles (n = 55), ground-glass opacity (n = 51), bronchiectasis (n = 50), interlobular septal thickening (n = 28), and consolidation (n = 5). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 70). Pathologically, these findings corresponded to lymphocytic infiltration along respiratory bronchioles and bronchovascular bundles. Pleural effusion and enlarged lymph nodes were found in two and five patients, respectively. CONCLUSION CT findings in patients with HTLV-1 consisted mainly of centrilobular nodules, ground-glass opacity, and thickening of the bronchovascular bundles in the peripheral lung. These CT findings are considered suggestive of thoracic involvement in patients with HTLV-1.
Collapse
Affiliation(s)
- Fumito Okada
- Department of Diagnostic and Interventional Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita 879-5593, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
We present 2 patients with chronic lymphocytic leukemia infiltration of the lung resulting in centrilobular nodularity on computed tomography. We present the x-ray and computed tomography patterns with pathological findings in these cases.
Collapse
Affiliation(s)
- William Moore
- Department of Radiology, Stony Brook University, Stony Brook, NY 11794, USA.
| | | | | |
Collapse
|
48
|
Abstract
Serous effusions are a common complication of lymphomas. Although the frequency of pleural effusion is 20-30% in non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD), the involvement of peritoneal and pericardial cavities is uncommon. Among lymphoma subtypes, T-cell neoplasms, especially the lymphoblastic lymphomas, more frequently involve the serous fluids. The thoracic duct obstruction and impaired lymphatic drainage appear to be the primary mechanism for pathogenesis of pleural effusion in HD and direct pleural infiltration is the predominant cause in NHL. There is wide variation in rate of positive cytologic findings of NHL in pleural effusion (22.2-94.1%). Cytologic features of specific lymphoma subtypes such as lymphoblastic lymphoma, follicular center cell lymphoma, including Burkitt-type lymphoma, marginal zone lymphoma, MALT lymphoma, and anaplastic large-cell lymphoma, etc., have been described in the literature. The differential diagnostic problems of lymphomas in serous effusions include reactive lymphocytoses, early involvement by lymphomatous process, small round-cell tumors (SRCT), and presence of look-alike of Reed-Sternberg cells. To overcome these difficulties, various ancillary studies, including immunocytochemistry (ICC), morphometry, flow cytometry (FCM), and cytogenetics/molecular genetics (PCR, in-situ hybridization, and Southern blotting), have been performed on effusion specimens. ICC not only distinguishes lymphomas from reactive lymphocytoses and SRCTs, it significantly modifies the morphologic diagnosis to achieve a better classification of lymphomas. Combined morphology and immunophenotyping by FCM, has a sensitivity as well as specificity of 100%. Morphometry also distinguishes reactive lymphocytoses from malignant lymphoma with a high degree of sensitivity (>85%) and specificity (>95%). Limitations of individual ancillary techniques can be overcome by using multiple parameters. Although lymphomas rarely present as serous effusions without the involvement of other thoracic and extrathoracic sites, a small group of lymphomas called primary effusion lymphomas (PEL) exhibit exclusive or dominant involvement of serous cavities, without a detectable solid tumor mass. This body cavity based lymphoma (BCBL) is a distinct clinicopathologic entity and is found predominantly in AIDS patients with preexisting Kaposi sarcoma. In the absence of obstructive or infiltrative tumor mass, its pathogenesis has been attributed to stimulation by vascular endothelial growth factor (VEGF)/vascular permeability factor (VPF), leading to vascular leakage. Cytomorphologically, PEL is usually a large-cell lymphoma, which appears to bridge features of large-cell immunoblastic and anaplastic large-cell lymphoma (ALCL). Most of these cases comprise a unique subgroup of B-cell lymphoma, with features of both high-grade anaplastic and B-immunoblastic lymphoma, but T-cell and/or natural killer cell immunophenotypes are described. Its association with various viral DNAs has been studied in detail by molecular techniques. Pleural effusion due to lymphomas, either primary or otherwise, is considered as one of the factors adversely influencing overall survival. The presence of pleural effusion at the time of presentation is not only associated with extremely poor outcome of lymphomas, it is also a predictor of disease relapse after chemotherapy and decreased survival. When the patients of lymphomatous pleural effusions with and without mediastinal mass present in respiratory distress, thoracocentesis is the initial diagnostic and therapeutic choice in these patients. In such situations, cytology along with ancillary studies not only gives a quick diagnosis of lymphoma, but also offers prognostically significant information such as classification of lymphomas, its grade and immunophenotype, and presence/absence of viral DNAs and tumor lysis syndrome.
Collapse
Affiliation(s)
- Dilip K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
49
|
Uffmann M, Schaefer-Prokop C. [Radiological diagnostics of Hodgkin- and non-Hodgkin lymphomas of the thorax]. Radiologe 2004; 44:444-56. [PMID: 15114475 DOI: 10.1007/s00117-004-1059-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Malignant lymphomas belong to the most important malignant diseases in western countries with an increasing incidence of Non-Hodgkin lymphoma. The thorax is the location of primary manifestation especially in patients with Hodgkin's disease. Progression of disease and therapy associated complications are frequently located in the chest. Based on morphological imaging criteria the two types of lymphoma cannot be differentiated, helpful for differentiation is, however, the way of disease spread. Primary and secondary thoracic lymphoma represent a diagnostic challenge in radiology: the patterns are variable in radiography as well as in computed tomography and alter under therapy. Radiological studies, especially CT, are an integral part of the staging process. MRI is considered advantageous for chest wall disease. PET as functional imaging technique has its proven role for staging of high grade lymphomas, the combination of functional and morphological information provided by PET-CT will become the first diagnostic standard in the future.
Collapse
Affiliation(s)
- M Uffmann
- Universitätsklinik für Radiodiagnostik, Allgemeines Krankenhaus Wien.
| | | |
Collapse
|