Pulmonary infiltrates--diagnostic problems in lymphoma

Abstract

Summary:The use of invasive investigations in immunocompromised patients with pulmonary infiltrates is controversial. We report a series of 22 pulmonary lesions occurring in 19 patients with underlying Hodgkin's (7) and non-Hodgkin's (12) lymphoma in whom invasive investigations were performed. The principle techniques used were fibreoptic bronchoscopy, bronchoalveolar lavage and transbronchial lung biopsy. A specific diagnosis was made on 12 occasions (55%). Involvement of the lung with lymphoma (6) and cytotoxic drug induced pneumonitis (4) were the commonest diagnoses, infection being found on only one occasion. In 15 of these 22 procedures (68%) the information obtained made a positive contribution to patient management.

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

“…The result of six of these studies from 1984 to 1995 5,7,[11][12][13][14] are summarised in Table 3. BAL is less invasive than TBB, is well tolerated and is essentially devoid of direct complications. BAL appears to have an equivalent diagnostic yield to TBB when the underlying diagnosis is infection as in PCP (90%) and Aspergillus (40-50%).…”

Primary malignant non-Hodgkin's lymphoma of the lung arising in mucosa-associated lymphoid tissue (MALT)

“…The case illustrates the difficulties in establishing the diagnosis (7)(8)(9), and shows that this kind of malignancy may remain localized for several years.…”

Primary Pulmonary Diffuse Large B-Cell Non-Hodgkin's Lymphoma in a Child

“…BAL has proved to be an extremely effective method for rapid diagnosis of many pulmonary infections in the immunocompromised host. 2 The prevalence of parenchymal pulmonary lesions in lymphoma in children has been observed to be 13% and all of them needed a biopsy for definitive diagnosis. 11 Patients with relapsed or primary refractory diffuse large B-cell lymphoma who achieve complete response before autologous stem-cell transplantation generally have better outcomes than those who achieve only partial response.…”

“…Involvement of the lung with the lymphomatous process occurs in 5% to 20% of patients at diagnosis and eventually in 20% to 60%. 2 We report the case of a 3-year-old girl who presented with pulmonary infiltrates mimicking miliary tuberculosis (TB) who was later diagnosed to have diffuse large B-cell NHL of the lung.…”