Linfomas Pulmonares: Correlação Da Tomografia Computadorizada De Alta Resolução Com a Anatomopatologia

Abstract

Neste trabalho são descritos os aspectos tomográficos de alta resolução dos linfomas pulmonares e feita correlação com os achados anatomopatológicos. Com este objetivo, foram revisados as tomografias computadorizadas de alta resolução do tórax e os dados histopatológicos de dez pacientes com diagnóstico confirmado de linfoma não-Hodgkin ou de doença de Hodgkin. Os resultados obtidos foram confrontados com os descritos na literatura. Os achados radiológicos mais comumente vistos neste estudo foram as consolidações parenquimatosas, localizadas, com broncogramas aéreos de permeio (n = 8). Em menor freqüência, foram encontrados múltiplos nódulos parenquimatosos (n = 4), espessamento peribroncovascular (n = 3) e opacidades em vidro fosco (n = 2). Na correlação com a anatomia patológica, as consolidações corresponderam a preenchimento alveolar por células neoplásicas, o espessamento peribroncovascular se deveu a infiltração das bainhas peribroncovasculares por células linfomatosas e a atenuação em vidro fosco se associou com infiltração dos septos alveolares por tais células. Unitermos: Linfomas pulmonares. Tomografia computadorizada de alta resolução. Anatomopatologia.Pulmonary lymphomas: high-resolution computed tomography and anatomopathological correlation. This paper describes the high-resolution computed tomography and anatomopathological findings of pulmonary lymphomas. We studied the chest high-resolution computed tomographies and histopathological data of 10 patients with biopsy-proven non-Hodgkin's or Hodgkin's disease. The most common radiologic findings in this series were areas of consolidation with air-bronchogram (n = 8). Other findings included multiple pulmonary nodules (n = 4), thickening of bronchovascular bundles (n = 3) and foci of groundglass attenuation (n = 2). The present series results are consistent with the current available literature on radiographic appearance of the disease. The pathological correspondence of the areas of airspace consolidation was alveolar filling by neoplastic cells, the thickening of bronchovascular bundles was secondary to lymphomatous cells infiltrates, and the areas of ground-glass attenuation corresponded to alveolar septal infiltration by these cells. INTRODUÇÃOO envolvimento linfomatoso do pulmão pode ser classificado em quatro categorias (1) : linfoma pulmonar primário, linfoma pulmonar secundário ou recorrente, linfoma em pacientes com alterações linfoproliferativas pós-transplante e linfomas relacionados à síndrome da imunodeficiên-cia adquirida (SIDA).Em relação aos tipos histológicos, os linfomas de Hodgkin (LH), caracterizados pela presença de células de Reed-Sternberg, têm quatro tipos básicos (2) : predomí-nio linfocítico, esclerose nodular, celularidade mista e depleção linfocítica. Os linfomas não-Hodgkin (LNH) são classificados em baixo grau, grau intermediário e alto grau, havendo diversos subgrupos em cada uma dessas categorias (2) . Linfomas pulmonares primários são linfomas extranodais raros, em geral do tipo não-Hodgkin. Tendem a permanecer loca...

Aspectos da tomografia computadorizada no linfoma em pacientes abaixo de 20 anos de idade

“…Contrarily to HL, NHL tends to manifest as a single, bulky lymph node mass, and not as individually increased lymph nodes. According to our results, in the chest, other sites are usually involved, such as pulmonary parenchyma, pleura and pericardium (2,10) .…”

“…The pulmonary disease, without lymph node involvement is more frequent in recurrent lymphomas. Pulmonary involvement is frequently asymptomatic and symptoms, when present, are usually nonspecific (8,10) . One characteristic of HL in the lung is the dissemination along the lymphatic route (10) and, in the mediastinum, the dissemination contiguously from a lymph node group to the next, with initial presentation in about 65%-80% of patients with abnormal chest x-ray (5,10) .…”

“…Pulmonary involvement is frequently asymptomatic and symptoms, when present, are usually nonspecific (8,10) . One characteristic of HL in the lung is the dissemination along the lymphatic route (10) and, in the mediastinum, the dissemination contiguously from a lymph node group to the next, with initial presentation in about 65%-80% of patients with abnormal chest x-ray (5,10) . In other studies (5) reporting a 98% frequency in patients with intrathoracic disease, we have observed a prevalence of mediastinal lymphadenopathy in relation to other sites, in the HL group, inclusive.…”

Linfangite carcinomatosa pulmonar como manifestação inicial de adenocarcinoma de ovário

“…The pulmonary architecture is preserved, with no evidence of lung parenchyma remodeling. (3) Pulmonary function tests are useful in making the differential diagnosis and usually show mixed respiratory disorder without diffusional alteration, as well as hypoxemia at rest, without hypercapnia. The diagnosis is typically based on specimens from a transbronchial biopsy or bronchoalveolar lavage.…”

“…The differential diagnosis should be made with other diseases that preferably present lymphatic dissemination, such as sarcoidosis, lymphoma, leukemia, paracoccidioidomycosis, Kaposi's sarcoma, diffuse pulmonary lymphangiomatosis, and lymphangiectasia. (3) Ovarian adenocarcinoma is not a common primary site of pulmonary carcinomatous lymphangitis, and is even less common when carcinomatous lymphangitis is found as the initial manifestation of the disease. This neoplasia, which accounts for 4% of all cases of cancer, typically presents peritoneal dissemination through metastatic cells in the free peritoneum.…”