Bronchiolitis obliterans organizing pneumonia in cancer: a case series

Abstract

Bronchiolitis obliterans with organizing pneumonia (BOOP) is an infrequently encountered clinical condition that can mimic a number of other pathologic lung processes. The presentation of this treatable condition in cancer patients has not been described in any large series. We conducted a retrospective study of patients with BOOP at Memorial Sloan-Kettering Cancer Center, NewYork, NY, U.S.A. from January 1992 to December 1999. The type and treatment of primary cancer, clinical and radiographic features of initial BOOP presentation, and outcome following therapy were recorded. Forty-three patients with an underlying diagnosis of cancer were found on lung biopsy to have BOOP as an isolated entity. BOOP was encountered in patients with a variety of clinical presentations, and many types of malignancies. The symptom patterns were non-specific, as were the physiological abnormalities. The only clear relationship between the underlying malignancyand the diagnosis of BOOP at presentation was in the chest radiographic findings. Patients with solid organ tumors were more likely to have nodular or mass like radiographic abnormalities (81%) than to have diffuse infiltrates (19%). We observed the opposite pattern in patients with hematologic malignancies (22% vs.67%). The vast majority of patients recovered from this condition. In conclusion, For cancer patients, BOOP represents a treatable cause of lung disease with protean manifestations. BOOP can mimic pulmonary malignancy and pulmonary infection. In cancer patients, the evaluation of new pulmonary symptoms accompanied by radiographic changes should include a consideration of this diagnosis.

Cryptogenic organising pneumonia

“…Organising pneumonia may occur in association with various haematological disorders or malignancies [90,93] including: acute myelomonocytic leukaemia with inversion of chromosome 16 [370]; acute lymphoblastic leukaemia [371]; chronic myelomonocytic leukaemia [372]; myelodysplastic syndrome [354,373,374]; T-cell adult leukaemia [375,376]; Evans syndrome [377]; Ewing sarcoma [371]; Hodgkin disease [371]; and various cancers with or without radiation therapy to the chest [378]. In patients with treated haematological malignancies and suspected invasive pulmonary aspergillosis, open lung biopsy may provide a diagnosis of organising pneumonia in up to ,20% of cases [379].…”

Rituximab-induced lung disease: a systematic literature review

“…Other causes of pneumonia were considered and ruled out in most patients. The histological data and course excluded pulmonary lymphoma relapse, lymphoma-related organising pneumonia [45], rheumatoid lung disease and other respiratory diseases. Doubtful cases were excluded [14][15][16].…”

Bronchiolitis Obliterans Organising Pneumonia (BOOP) in a lung cancer patient after lobectomy

“…The occurrence of BOOP in association with malignancy including lung cancer has been reported [2,5]. The pathological finding of organizing pneumonia adjacent to a resected lung tumor was actually common.…”

“…Arrabal Sanchez et al reported a case of adenocarcinoma found in a patient at a different part of his lung during thoracoscopic lung biopsy for a lung lesion, which was diagnosed as BOOP [5]. In a study by Mokhtari et al, among 43 cases of BOOP in association with cancer, 10 were associated with lung cancer but they all had received treatment in the form of chemotherapy and/or radiotherapy [2]. The occurrence of BOOP immediately after resection of lung cancer without adjuvant therapy, to the best of our knowledge, has never been reported in literature.…”

“…It is characterised by a variable clinical and radiographic picture but a distinct pathological appearance together with a dramatic response to corticosteroid therapy. BOOP has been reported to be associated with malignancy and its treatment [2]. However, in the majority of cases it seemed to be either a silent pathological process in the vicinity of a tumour or an active symptomatic disease secondary to anti-cancer therapy like radiotherapy and /or chemotherapy.…”