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THE FOLLOWING IS A BRIEF REVIEW OF THE RADIOLOGICAL PRESENTATIONS AND PATHOLOGIC CRITERIA OF ANAPLASTIC LYMPHOMA
PRINCIPAL ASPECTS DISCUSSED AT THE TELECONFERENCE ARE SUMMARIZED
1-GENERALITY
Found primarily in children more than 3 years of age with a peak incidence from 8 to 14 years. More than 95% of children with Pulmonary lymphomas have lymph node enlargement as a presenting sign.
Sometimes:
– tonsilar hypertrophy
– adenoidal hyperplasia
– pulmonary hilar enlargement
– splenomegaly
– bone pain
– unexplained fever
– anemia
– infiltrative skin lesions
– rarely CNS symptoms
–
acute
or subacute bilateral alveolar infiltrate may be a rare presentation
2 – CHEST XRAY MANIFESTATIONS
2.1
– introduction
Large and small lymphocytic forms differ:
large – predominantly mediastinal and hilar enlargement
small – pleuropulmonary involvement
in
Burgener, Hamlin AJR 1981:
large forms may invole lung parenchyma in half of the cases (n=56/112).
Of
these 56 patients:
28/56 
(50%)
mediastinal
node enlargement
19/56
(34%) hilar
node enlargement
22/56 (40%)
pulmonary
involvement
20/56
(36%) pleural
involvement
2.2-mediastinal enlargement +++
–
ANTERIOR UPPER MEDIASTINUM MOST OFTEN INVOLVED
– MIDDLE MORE OFTEN INVOLVED BY A LYMPHADENOPATHY
– POSTERIOR, if extension.
2.3 – pulmonary involvement ++
2.3.1 – mass like +/- adenopathy
2.3.2
– diffuse reticulonodular patterns
14/56
(26%)
Burgener, Hamelin AJR 1981
13/27
Balikian, Herman radiology 1979
pediatrics
1
case report
Sherman
Pediatrics 1997
sometime
septal lines like lymphangitic carcinoma
LIP like 2 cases
Valeyre
Presse med 1985
2.3.3
– nodular
frequent for some authors but with CT
Lewis et al. AJR 1991
often not shown on CXR
2.3.4 – miliary rare
2.3.5
– pleural effusion transgression of fissures and pleura
20/56(20%)
Burgener,
Hamelin AJR 1981
16/138(12%)
Koss et al Hum pathol 1983
26/200(13%)
Xaubet et al Eur J Resp Dis 1985
2.3.6
– pericardial effusion
from medistinal nodes
Kreel clin radiol 1962
2.3.7 – cavitation uncommun
2.3.8 – adenopathies frequently associated
2.3.9
– ARDS
In a case report, a 12 yo patient, had fever, cervical
nodes enlargement, hepatosplenomegaly, interstitial infiltrates and rapidly
respiratory failure with evidence of an ARDS
Sherman J Pediatr 1997.
ARDS
has multiple causes including
– infectious agents
– inhalation of toxic gases or other toxic compounds
– AI disorders
– various drugs that produce lung injury through a HS reaction
– and certain malignant diseases in which the acute lung injury
appears to be cytokine mediated
Reynaldo
et al. N Engl J Med 1982
2.3.10
– BOOP like
case report
Safadi et al. Leuk Lymphoma
1997
2.3.11
– Lymphoma arising in cryptogenic fibrosing alveolitis
Orchad et al. Thorax 1998
2.3.12
– parenchymal consolidation not so rare
simulating acute airspace pneumonia from segmental
to whole lobe or entire lung
Baron AJR 1961, Robbins cancer
1953
alveolar form present either as a primary lesion of the lung or a part
of a disseminated disease
Robins cancer 1953, Garrison
mayo clin proc 1969
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