Primary Lymphoma of the Lungs

Am J Clin Pathol 2004;121:718-726 Abstract quote

Secondary lung infiltration by lymphomas occurs frequently. To our knowledge, however, no recent studies have attempted to discriminate histologic patterns of lung infiltration in the lymphoma subtypes.

We retrospectively evaluated the frequency of lung infiltration and the respective infiltration patterns by lymphomas at autopsy, during an 11-year period. Lymphomas were classified according to the 2001 World Health Organization Classification of hematologic malignancies in B-cell, T-cell, and Hodgkin lymphomas (HLs). In 21,157 autopsies, 414 reports with lymphoma diagnosis were reviewed histologically, and 85 showed lung infiltration (20.5%). We studied 14 HLs, 43 B-cell lymphomas, and 20 T-cell lymphomas. Five infiltration patterns were identified: peribronchial-perivascular, nodular, alveolar, interstitial, and pleural. Approximately half of the lymphomas had more than 1 infiltration pattern (mean, 1.7); peribronchial-perivascular and pleural were the most frequent. The frequency of nodular infiltration was larger in HL than in B-cell lymphomas. T-cell lymphomas had a larger frequency of the interstitial infiltration pattern compared with B-cell lymphomas.

Recognizing the frequency and patterns of lung infiltration in the light of a more recent classification is certainly useful for physicians dealing with lymphoma diagnostic procedures, such as radiologists and pathologists.

Epidemiology
Disease Associations
Pathogenesis
Laboratory/ Radiologic/ Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/ Immunohistochemistry/ Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

EPIDEMIOLOGY	CHARACTERIZATION
SMOKING	Chest 1993;103:201-208 Possible association in 27/66 cases of lymphoma

GROSS APPEARANCE/ CLINICAL VARIANTS	CHARACTERIZATION
VARIANTS
Cavitary mass	Chest 1993;103:201-208 Clin Radiol 1994;49:883-885 This presentation is occasionally seen in high grade pulmonary lymphomas
Endobronchial mass	AJR Am J Roentgenol 1961;85:87-95 Mod Pathol 2000;13:1285-1292

DIFFERENTIAL DIAGNOSIS	CHARACTERIZATION
NODULAR LYMPHOID HYPEPLASIA
Nodular Lymphoid Hyperplasia of the Lung A Clinicopathologic Study of 14 Cases Susan L. Abbondanzo, M.D.; Walter Rush, M.D.; Karen E. Bijwaard, M.S.; Michael N. Koss, M.D. From the Departments of Hematopathology (S.L.A.), Pulmonary and Mediastinal Pathology (W.R., M.N.K.), and Cellular Pathology (K.E.B), Armed Forces Institute of Pathology, Washington, DC, U.S.A.	Am J Surg Pathol 2000;24:587-597 Abstract quote Nodular lymphoid hyperplasia is a controversial entity in which its existence in the lung has been doubted. The current opinion is that most, if not all, such cases represent extranodal marginal zone B-cell lymphomas masquerading as reactive lesions. We found 14 cases of nodular lymphoid hyperplasia in the files of the Pulmonary Department at the Armed Forces Institute of Pathology from 1974 through 1998. All had clinical histories and hematoxylin�eosin slides. In 12 of 14 with paraffin blocks, we applied immunohistochemical antibodies for CD20, CD3, CD43, CD5, bcl-2, bcl-1, CD45RA, and kappa and lambda immunoglobulin light chains. Molecular genetic analysis was performed on paraffin sections in 10 of 14 by the polymerase chain reaction for rearrangements of the immunoglobulin heavy chain gene and the minor and major break-point regions of the chromosomal translocation t (14;18). There were eight women and six men ranging in age from 19 to 80 years (median, 65 yrs). Most lesions (71%) were incidental findings on routine chest x-rays. Most patients (64%) had a single lesion by chest x-ray whereas the remainder had two to three lesions, except for one patient who had ``multiple'' lesions. There was associated regional lymphadenopathy in five of 14 cases (36%) which, on biopsy, proved to be reactive follicular hyperplasia. The only treatment was surgical excision. Of the seven patients with follow-up information from 8 months to 6 years (mean, 30 mos), none had clinical recurrence and no patient died of disease. The histology and immunophenotype of the lesions were strikingly similar, including abundant reactive germinal centers, intense interfollicular polyclonal plasmacytosis, and a variable degree of interfollicular fibrosis. No case showed a molecular rearrangement of the immunoglobulin heavy chain gene or the minor or major break-point region of the t (14;18). We conclude that nodular lymphoid hyperplasia of the lung, although rare, does exist and deserves its place in the spectrum of reactive pulmonary lesions that ranges from follicular hyperplasia to diffuse hyperplasia of the bronchus-associated lymphoid tissue (lymphoid interstitial pneumonitis).
SECONDARY INFILTRATION BY LYMPHOMA
Histologic Patterns of Lung Infiltration of B-Cell, T-Cell, and Hodgkin Lymphomas Maria B.G. Costa, MD, PhD, Sheila A.C. Siqueira, MD, Paulo H.N. Saldiva, MD, PhD, Klaus F. Rabe, MD, PhD, and Thais Mauad, MD, PhD	Am J Clin Pathol 2004;121:718-726 Abstract quote Secondary lung infiltration by lymphomas occurs frequently. To our knowledge, however, no recent studies have attempted to discriminate histologic patterns of lung infiltration in the lymphoma subtypes. We retrospectively evaluated the frequency of lung infiltration and the respective infiltration patterns by lymphomas at autopsy, during an 11-year period. Lymphomas were classified according to the 2001 World Health Organization Classification of hematologic malignancies in B-cell, T-cell, and Hodgkin lymphomas (HLs). In 21,157 autopsies, 414 reports with lymphoma diagnosis were reviewed histologically, and 85 showed lung infiltration (20.5%). We studied 14 HLs, 43 B-cell lymphomas, and 20 T-cell lymphomas. Five infiltration patterns were identified: peribronchial-perivascular, nodular, alveolar, interstitial, and pleural. Approximately half of the lymphomas had more than 1 infiltration pattern (mean, 1.7); peribronchial-perivascular and pleural were the most frequent. The frequency of nodular infiltration was larger in HL than in B-cell lymphomas. T-cell lymphomas had a larger frequency of the interstitial infiltration pattern compared with B-cell lymphomas. Recognizing the frequency and patterns of lung infiltration in the light of a more recent classification is certainly useful for physicians dealing with lymphoma diagnostic procedures, such as radiologists and pathologists.

PROGNOSIS AND TREATMENT	CHARACTERIZATION
Prognostic Factors
Survival	Histopathology 1990;16:519-531 5YRS of 60% for high grade lymphomas