Lymphomatoid granulomatosis (LG) is a rare T cell rich, B cell non-Hodgkin's lymphoma which is difficult to diagnose. We present a patient with LG who demonstrated many of the difficulties in diagnosis and highlighted the importance of reviewing the diagnosis if treatment does not have the anticipated effect.A 49 year old male smoker presented to another hospital with a 3 month history of weight loss and sweats. A chest radiograph showed a mass in the left lower lobe and bronchoscopic examination revealed inflammation involving the left lower lobe bronchus. Washings were negative for organisms and malignancy. A computed tomographic (CT) scan showed a cavitating mass in the left lower lobe with multiple smaller opacities throughout both lung fields. Percutaneous fine needle aspiration of the mass showed inflammation with necrotic debris. He was discharged but presented 1 week later with fever and rigors and was transferred to this hospital.On arrival he had a cough productive of copious, foul smelling, purulent sputum. His temperature was 40˚C. There was no lymphadenopathy or hepatosplenomegaly. Neurological examination was normal. C-reactive protein (CRP) was 59 mg/l. Blood, urine and sputum cultures, white cell count, serum angiotensin converting enzyme, P-and C-ANCA, autoantibody screen, complement, test for HIV, viral screening, and brucella titres were all negative or normal. A repeat bronchoscopic examination was non-diagnostic. A repeat CT scan showed a 7 cm cavitating lesion in the left lower lobe with an air/fluid level and minor ''inflammatory changes'' in the right lung.Empirical treatment for a suspected lung abscess was commenced using intravenous benzylpenicillin, gentamicin, and metronidazole. Over the next 21 days his pyrexia settled, sputum cleared, and the CRP level normalised. The chest radiograph remained unchanged. Four weeks later his purulent sputum, fever, and raised CRP level recurred. Open lung biopsy was considered, but the thoracic surgical team declined because of the evidence for active infection. Antibacterial therapy was recommenced with intravenous cefotaxime and metronidazole. As before, there was a good clinical response but without radiological resolution. Further symptomatic relapse occurred once the drugs were withdrawn. Seven months after initial presentation he deteriorated further. A CT scan showed the left lower lobe cavity unchanged but there were now numerous nodular densities throughout the right lung (fig 1). Repeat bronchial biopsies showed abnormal lymphoid tissue characterised by a polymorphous lymphoid infiltrate containing scattered enlarged blast-like cells. These stained positively for CD20, a B cell marker, and immunoglobulin rearrangement studies showed clonality. These findings suggested lymphomatoid granulomatosis.He was treated with methylprednisolone, vinblastine, and cyclophosphamide. Within 2 weeks his dyspnoea, fever, and right sided radiological abnormalities resolved. The left lower lobe lesion reduced by 40% after three cycles of chemotherapy. Howev...
Fourteen cases of breast lymphoma, identified from hospital records between 1990 and 2004, were reclassified according to the World Health Organisation criteria. Primary cases occurred more frequently and all cases were of B cell origin, predominantly involving the right breast. Most primary cases were diffuse large B cell lymphomas, whereas secondary cases were heterogeneous in type and most had a poor prognosis.
Breast lymphoma accounts for less than 1% of all non-Hodgkin's lymphomas (NHLs) and approximately 0.1% of all breast neoplasms. Most breast lymphomas are classified as diVuse large B cell or mucosa associated lymphoid tissue (MALT) lymphomas. The case of a 53 year old woman presenting with a breast mass and found to have mantle cell lymphoma is described. Core biopsy of the breast lesion showed a B cell NHL, probably of large cell type and of high grade. Morphological and immunophenotypic analysis of peripheral blood and bone marrow samples suggested a mantle cell lymphoma (MCL). This was confirmed by the detection of a t(11;14) in the bone marrow aspirate and breast tissue by polymerase chain reaction analysis. There have been no previous reports of an MCL presenting as a breast lump. Because a diagnosis of MCL has prognostic and therapeutic implications, this case highlights the need for an awareness of MCL presenting in this way, and the requirement for specialised investigations in its detection. (J Clin Pathol 2001;54:883-886)
IntroductionOesophageal adenocarcinoma (OAC) incidence rates have increased dramatically in recent decades, particularly among white males in Western societies.1 There appears to be a concurrent rise in Barrett's oesophagus (BO) incidence, the pre-cursor condition for OAC, although it is debated whether this is a true rise, or a reflection of changes in endoscopy practices together with improvement in disease recognition.2 The aim of our investigation was to assess BO incidence over a 13-year period using a population-based register in Northern Ireland.MethodsThe Northern Ireland Barrett's oesophagus Register (NIBR) is a population-based register of all adults diagnosed with BO, defined as columnar epithelium of the oesophagus, in Northern Ireland between 1993 and 2005. Data on all upper gastro-intestinal endoscopies and oesophageal biopsies performed in Northern Ireland were obtained from healthcare providers. Annual BO incidence rates were calculated per 100 000 of the population, per 100 endoscopies and per 100 oesophageal biopsies performed.ResultsDuring the 13-year period, 197 635 patients underwent an endoscopy and 9390 of these were diagnosed with BO, of whom 58% were male. Average annual BO incidence rates over this time period are presented in Abstract 072. A 2.5-fold increase in BO incidence in the population was observed. Over the same time, there were 1.3 and 1.6-fold increases in endoscopy and biopsy rates in the population, respectively. Even with the increasing rates of endoscopy and biopsy, BO was still diagnosed more frequently per 100 endoscopies and per 100 biopsies. Abstract PWE-072Average annual BO incidence rates in Northern IrelandTime periodBO incidence/100 000Endoscopies/100 000BO incidence/100 endoscopiesOesoph biopsies/100 000BO incidence/100 biopsies1993–199732.213342.4160424.81998–200161.616923.6226734.92002–200580.317564.6265140.1 ConclusionThese findings demonstrate that BO incidence rates in Northern Ireland have increased more rapidly than the rate of endoscopies or biopsies. This could indicate that a true rise in BO incidence has occurred, contributing to the increase in OAC seen in Western populations. This may have implications for efforts to prevent OAC.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.