Primary pulmonary Hodgkin's lymphoma (PPHL) is rare. PPHL without peripheral lymphadenopathy or hepatosplenomegaly is exceptionally uncommon. We present a 61-year-old woman believed to have a solitary intrapulmonary fibrous tumour on a CT and a CT-guided biopsy, until surgical excision. Histopathology and immunohistochemistry of the excised mass confirmed PPHL. PPHL is a very rare differential diagnosis of large solitary intrapulmonary masses. A CT-guided biopsy is recommended, as it can be diagnostic, reserving excision for cases where the diagnosis remains in doubt.
Advances in our understanding of lung adenocarcinoma have led to the recently revised classification of lung adenocarcinoma. This replaces the term bronchoalveolar carcinoma and introduces the concept of preinvasive, minimally invasive, and frankly invasive lesions to the classification. Although more work is required to validate these concepts, it is likely that they will be incorporated into the next World Health Organization and TNM classifications. We illustrate the likely radiographic appearance of lesions in the new classification, highlight salient features to watch for on follow-up, and offer guidance on their management.
IntroductionThe weekly Bristol Interstitial Lung Disease (BILD) multidisciplinary team (MDT) meeting decides consensus diagnoses for patients from around the South West. A database records cases at the time of discussion. Referrals have increased since the advent of novel agents for Idiopathic Pulmonary Fibrosis, prompting this retrospective review of the MDT experience.AimsEstablish the range of cases referred, determining the proportion for whom MDT discussion leads to changes in diagnosis and which variables influence this. Examine IPF patients, identifying differences between those prescribed Pirfenidone or otherwise.MethodsFor all cases recorded in the MDT database between 1/1/2013 and 1/1/2015, the pre-MDT differential diagnosis and consensus diagnosis, dates of referral/discussion, referral source, demographics, investigation results, the number of discussions and dispensing of Pirfenidone were reviewed. For patients with multiple entries, initial differential diagnoses were compared to final consensus. Outcome measures of interest were change in diagnosis and decision to use Pirfenidone in IPF patients.Results846 discussions occurred (651 individual patients) over this period. Pre/post MDT diagnoses are shown in the Table 1. 78% of cases were discussed within 2 weeks of referral. 25% were discussed more than once (range 1–5). 54.7% of IPF cases were external referrals vs 32.3% overall.Diagnosis changed following discussion for 44.1% of patients. Pre-MDT diagnosis of IPF changed for 36.7%. Logistic regression suggests pre-MDT differential diagnosis and age at referral are main influences on change in diagnosis.Overall mean age was 65.5 years (17–91), 58.1% male. For IPF cases, mean age was 74.4 years, 76.9% male. Pirfenidone was prescribed to 46.2% of IPF cases; median time to dispensing 61 days. 6MWD was greater where Pirfenidone was given (284 m vs 249 m, p = 0.03); however lung function and HRCT pattern did not differ. 12-month mortality was 6.7% in the Pirfenidone group, 27.1% where not given (p = 0.002).Abstract P29 Table 1Pre-MDT diagnoses and consensus diagnoses following MDT discussionDiagnosisPre-MDT DiagnosisConsensus diagnosis1 year transplant free survivaln%n%%Asbestosis101.5111.781.8CPFE264.0335.178.8CT-ILD7912.16810.498.5Drug Related ILD162.5142.292.9Hypersensitivity pneumonitis639.77110.985.9IPF15023.013020.081.5No ILD20.36510.089.2NSIP477.27311.284.9NSIP/UIP Spectrum121.86.983.3Organising pneumonia111.7111.790.9Other (including vasculitis, DIP, LAM etc)335.1304.690Pulmonary Langerhans Cell Histiocytosis50.871.1100RB-ILD101.5132.0100Sarcoidosis8412.97411.497.3Unclassifiable ILD10315.8456.984.3Total651100.0651100.088.2CPFE: Combined Pulmonary Fibrosis/Emphysema, CT-ILD: Connective Tissue disease-associated ILD, IPF: Idiopathic Pulmonary Fibrosis, NSIP: Non-specific Interstitial Pneumonia, UIP: Usual Interstitial Pneumonia, RB-ILD: Respiratory Bronchiolitis-ILD, DIP: Desquamative Interstitial Pneumonia, LAM: LymphangioleiomyomatosisConclusionSpecialist MDT discussion influenced changes in diagn...
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