Pulmonary Lymphoproliferative Disorders

Thompson, Gregory P.; Utz, James P.; Rosenow, Edward C.; Swensen, Stephen J.

doi:10.1016/s0025-6196(12)60642-9

Cited by 15 publications

(9 citation statements)

References 116 publications

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“…Certain neoplasms can result in diffuse air-space disease and there have been reports of pulmonary lymphoproliferative disorders that give rise to recurrent infiltrates as early as 5 years before the definite diagnosis is made (20)(21)(22)(23). However, lung involvement without thoracic lymph-node involvement is extremely rare (22).…”

Section: Discussionmentioning

confidence: 99%

Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology

Bleyenbergh¹,

Nemery²,

Nolard³

et al. 2001

Respiratory Medicine

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Migrating pulmonary infiltrates present a difficult diagnostic and therapeutic challenge. We report on eight patients (mean age 51 years, range 32-78 years, with a prolonged history of migrating pulmonary infiltrates of unknown aetiology despite a very elaborate search for infectious causes, hypersensitivity pneumonitis or inhalation fever due to occupational or domestic exposure to fungi, or to other environmental causes, and for humoral or cellular immunological incompetence. These patients (one male, seven females) presented with recurrent episodes (mean 6, range 2-13) of a flu-like illness, often with cough, wheezing and pleuritic chest pain, but without systemic involvement. Previous medical histories were unremarkable. There was no relation with smoking habits, occupation, drug use or other possible exposures. Biochemical data were non-specific. There was no peripheral nor pulmonary eosinophilia; total IgE was normal, with negative RASTs and precipitins to a variety of antigens. Cultures and serological tests for bacteria, viruses, fungi, etc were non-contributory. Chest X-ray and computed tomography (CT) scan showed bilateral migratory pulmonary infiltrates, with a predilection for the middle and lower lung zones, often with a minor-to-moderate pleural effusion. Lung function tests were usually normal; at the most a slight decrease in diffusing capacity was noted in some patients. There was no or only a slight response to antimicrobials; systemic corticosteroids were not given. Further evolution was benign with patients being asymptomatic between the episodes. Despite elaborate investigations, the cause of these 'pneumonias' remains frustratingly unknown.

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Section: Discussionmentioning

confidence: 99%

Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology

Bleyenbergh¹,

Nemery²,

Nolard³

et al. 2001

Respiratory Medicine

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“…5) and the visceral pleura, presumably accounting for the pleural effusion. The histologic findings represent an early phase of lymphocytic interstitial pneumonitis, [12][13][14] which is believed to be a form of diffuse lymphoid hyperplasia, 12 occurring where lymphoid tissue is normally found in the lungthat is, along lymphatic pathways. One form of lymphoid hyperplasia with peribronchiolar predominance has been referred to as follicular bronchiolitis.…”

Section: Clinical Diagnosesmentioning

confidence: 99%

“…Lymphocytic interstitial pneumonitis can be a precursor or an early manifestation of well-differentiated lymphocytic lymphoma in the lung 13,15,16 and can also progress to a high-grade malignant lymphoma. 17 In contrast to the monoclonal cells characteristic of a malignant lymphoma, both T and B cells were present in this case, and there was no lightchain restriction in the lymphocytes.…”

Section: Clinical Diagnosesmentioning

confidence: 99%

“…18 Primary biliary cirrhosis can be accompanied by lymphocytic interstitial pneumonitis 9,12,19 as well as by fibrosing alveolitis, pleural effusions, pulmonary hemorrhage, and pulmonary hypertension. 3,[20][21][22][23] Other diseases associated with lymphocytic interstitial pneumonitis are Sjögren's syndrome, a potpourri of polyclonal and monoclonal lymphoproliferative processes, various gammopathies, myasthenia gravis, collagenvascular diseases, chronic active hepatitis, [12][13][14] and infections with Epstein-Barr virus, 24 human immunodeficiency virus, 25 and human T-cell lymphotropic virus type I. 26 Lymphocytic interstitial pneumonitis may be familial, 27 may reflect depressed cellular immunity, 28 and may be a manifestation of graft-versus-host disease in recipients of bone marrow transplants.…”

Section: Clinical Diagnosesmentioning

confidence: 99%

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Case 14-1998

Reilly¹,

Mark²

1998

N Engl J Med

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“…22 Primary pulmonary lymphoproliferative disorders must be considered in the differential diagnosis of this case. 29,30 They include lymphocytic interstitial pneumonitis, lymphomatoid granulomatosis, and lymphoma. Lymphocytic interstitial pneumonitis is typically associated with an interstitial pattern on lung radiographs, although an alveolar pattern has also been described.…”

mentioning

confidence: 99%

Case 40-1996

White¹,

Mark²

1996

N Engl J Med

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A 58-year-old man was admitted to the hospital because of respiratory distress and hypotension.Seven years before admission, a routine radiograph of the patient's chest had been reported to show a "black spot" in a lung. He declined follow-up examinations. Fifteen months before admission, he began to have a chronic cough productive of clear sputum, progressive exertional dyspnea, fatigue, and weight loss. Seven months before admission, he immigrated to the United States from a Caribbean island to be cared for by his daughters who resided in this country. Two weeks later, he came to this hospital.The patient had been a construction worker for several years, with exposure to sprayed pesticides. He drank alcohol heavily but never smoked. There was no history of chest pain, hemoptysis, wheezing, fever, chills, sweats, tuberculosis or exposure to it, hypertension, coronary artery disease, or diabetes mellitus, and there were no risk factors for human immunodeficiency virus (HIV) infection except for several recent sex partners.The temperature was 37.2°C, the pulse was 80, and the respirations were 18. The blood pressure was 105/70 mm Hg.Examination revealed cachexia and diminished breath sounds at the left base and the lower half of the right lung and fine inspiratory crackles over the right middle lobe. No wheeze was heard. A grade 2 holosystolic murmur was present along the left sternal border. No peripheral edema, digital clubbing, or cyanosis was present.The urine was normal. Laboratory tests were performed (Tables 1 and 2). An electrocardiogram showed a normal rhythm at a rate of 81, with an R-wave axis of ϩ 73 degrees and right atrial enlarge-ment; the R waves were absent in leads V 1 and V 2 , with low-to-inverted T waves in leads V 1 through V 3 . Radiographs of the chest (Fig. 1) showed volume loss in the left lung, with a leftward shift of the mediastinum and trachea. There was extensive air-space disease in the left lung, with focal cavitation or cyst formation and bronchiectasis, especially in the upper lobe. The right lung was hyperinflated, with air-space disease and multiple nodular opacities, particularly in the perihilar region and in the lower lobe, where many of the opacities were confluent. The left costophrenic angle was blunted, a finding consistent with pleural effusion or thickening. The heart border was obscured by the lung disease. Microscopical examination of sputum smears showed a few acid-fast bacilli. Cytologic studies of the sputum revealed no tumor cells. A skin tuberculin test (purified protein derivative, 5 TU) was strongly positive; a test for mumps antigen was positive, and a test for candida antigen was negative. A serologic test for HIV antibodies was negative.The patient was admitted to a negative-pressure isolation room and was given isoniazid, rifampin, pyrazinamide, ethambutol, and pyridoxine. He remained afebrile, and his condition began to improve, with a diminished cough, after a 14-day course of *The control value was 11 seconds.

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Pulmonary Lymphoproliferative Disorders

Cited by 15 publications

References 116 publications

Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology

Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology

Case 14-1998

Case 40-1996

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