Objective To investigate the relevance of primary pulmonary non-Hodgkin’s lymphoma ( PPNHL) imaging with pathology features, so as to improve the diagnostic accuracy. Methods Twenty-two patients of PPNHL were scanned by chest computed tomography, and the results of clinical and pathology features were analyzed. Results The resulting pathologic examination showed that all patients in 12 cases of low-grade lymphoma had MALT lymphoma( 54. 5% ) , histologically with slightly atypical small lymphocyte proliferated. The radiological findings indicated unilateral peripheral lesion which extended along mucous membrane in 11 patients ( 91. 7% ) and multilateral lesion in only 1 patients ( 8. 3% ) . CT features were illdefined nodule or mass with halo sign ( n =8, 66. 7%) , patchy infiltrate ( n = 4, 33. 3% ) , and ill-defined consolidations with air-bronchograms ( n =7, 58. 3% ) . The resulting pathologic examination showed that 10 patients were high and middle-grade lymphoma ( 45. 5% ) . The radiological findings indicated unilateral lesion in4 patients ( 40%) and multilateral lesion in 6 patients( 60% ) . CT features were ill-defined noduleor mass ( n =4, 40% ) , patchy infiltrate ( n = 1, 10% ) , mixed manifestation ( n =5, 50% ) , pleural effusion ( n =5, 50% ) , hilar and mediastinal lymph node enlargement ( n =2, 20% ) , atelectasis ( n =3, 30%) , and pulmonary interstitial with interlobular septal thickening ( n=2, 20% ) . Conclusions The imaging features of PPNHL rely on its’ basic pathology. Low-grade lymphoma is characterized by peripheral focal consolidation with air-bronchograms. High and middle-grade lymphoma is characterized by mixed manifestation of interstitial change and nodular focus. Analyzing CT features seriously may be helpful for diagnosis of PPNHL.
ObjectiveTo observe the image characteristics of optical coherence tomography (OCT) in patients with primary vitreoretinal lymphoma (PVRL).MethodsA retrospective clinical study. Thirty-two eyes of 19 patients diagnosed with PVRL by vitreous pathology in the Department of Ophthalmology, Beijing Tongren Hospital from September 2016 to October 2019 were included in this study. There were 7 males and 12 females. The median age was 56 years. The mean time from symptom onset to final diagnosis was 6.1±3.8 months. The first diagnosis was uveitis in 12 cases (63.1%, 12/19), retinal vein occlusion in 2 cases (10.5%, 2/19), central retinal artery occlusion in 1 case (5.3%, 1/19), and suspected PVRL of camouflage syndrome in 4 cases (21.1%, 4/19). Routine ophthalmic examination and frequency-domain OCT examination were performed in all the patients, and typical images were stored for analysis. According to the examination results, PVRL OCT signs were divided into vitreous cells, inner retinal infiltration, outer retinal infiltration, retinal pigment epithelial (RPE) infiltration, sub-RPE infiltration, and subretinal fluid.ResultsVitreous cells were found in all eyes (100.0%, 32/32). RPE infiltrated were observed in 19 eyes (59.4%, 19/32), RPE infiltration in 16 eyes (50.0%, 16/32), outer retinal infiltration in 8 eyes (25.0%, 8/32), inner retinal infiltration in 16 eyes (50.0%, 16/32), and subretinal fluid in 4 eyes (12.5%, 4/32).ConclusionsPVRL OCT signs can involve vitreous and retinal anatomical levels, including vitreous cells, inner retinal infiltration, outer retinal infiltration, RPE infiltration, sub-RPE infiltration and subretinal fluid. The same patient can show multiple signs at the same time.
Objective To explore the clinical characteristics of patients with lymphoma firstly manifested as symptoms in respiratory system. Methods The clinical data of 9 patients with lymphoma were analyzed retrospectively and discussed with literature review. Results There were 7 males and 2 females with an average age of 48.2 years and a median disease course of 20 days. All patients were diagnosed by pathology while specimens were obtained by cervical lymph node biopsies in 2 cases, by CT-guided percutaneous lung biopsies in 2 cases, by bronchoscope mucosal biopsies in 2 cases, by transbronchial needle aspiration biopsies in 1 case, by thoracoscope lung biopsies in 1 case, and by ascites cell block inspection in 1 case. The main symptoms were cough (7/9), expectoration (3/9), fever (3/9) and wheeze (2/9). Chest CT showed tumors (3/9, multiple in 1 case), enlarged mediastinal lymph nodes (6/9), enlarged hilar lymph nodes (3/9), pulmonary consolidation (3/9), pleural effusion (6/9, bilateral in 3 cases), pleural thickening (2/9), pulmonary atelectasis (2/9), patchy shadow (7/9), pericardial effusion (1/9). Laboratory examination demonstrated elevated cancer antigen 125 (CA125) in 7 cases while elevated lactic acid dehydrogenase (LDH) in 4 cases. One patient died during hospitalization in the respiratory department, 1 patient auto-discharged without further treatment, 1 patient died in follow-up period. Five patients remain alive up to now. Conclusions The symptoms of patients with lymphoma are atypical while the chest radiological findings are varied. CA125 and LDH play important role in evaluating disease and predicting prognosis in patients with lymphoma.
ObjectiveTo explore the clinical characteristics, diagnosis and treatment methods of pulmonary mucosa-associated lymphoid tissue lymphoma. MethodsClinical manifestations, laboratory examinations, imaging, diagnosis and treatment data of 23 patients with pulmonary mucosa-associated lymphoma were collected and related literatures were reviewed. ResultsAmong the 23 patients, 14 were males and 9 females, aged 22 to 71 years old, with a median age of 58 years old. Seven patients were found in physical examination, 15 patients showed respiratory symptoms, and 1 patient was diagnosed with flatness on percussion. According to the pulmonary CT scan, 10 patients showed large consolidations, 9 patients showed mass shadows with air bronchograms, 10 patients showed nodular shadows, 1 patient showed small reticular shadows, and 1 patient was observed with subcarinal mass in the mediastinum; 1 patient was observed with a decreased lung volume. Immunohistochemistry examination showed CD20 (+), cyclind-1 (-), and Ki-67 index was from 5% to 25%. Ten patients were treated with chemotherapy, 9 patients were treated with surgery, 1 patient was treated with radiotherapy and surgery, and 3 patients were untreated. ConclusionsPulmonary mucosa-associated lymphoid tissue lymphoma is a low-moderate malignant tumor, with insidious clinical onset, and patients usually go for treatment due to physical examination and mild respiratory symptoms. Imaging findings are mainly pulmonary consolidation and mass shadows associated with air bronchograms. Confirmed diagnosis is primarily made by pathology and immunohistochemistry. Currently, there is still some controversy over a variety of treatment options, including observation, surgery, surgery combined with chemotherapy, chemotherapy alone, and radiotherapy. The patients' prognosis and survival time are both excellent.
Objective To observe the ocular features and analyze the cause of misdiagnosis of intraocular nonHodgkin's lymphoma (IONHL). Methods A retrospective study was performed in 6 patients and related literatures were reviewed. The age of those patients was 46 to 68 yrs with an average of 562 yrs. Four cases were female, two cases were male. Five patients were unilateral and one case was bilateral case. All patients were investigated by Goldmann tonometer, fundus fluorescein angiography (FFA) and ophthalmic Bscan. Pathological samples come from enucleation and vitrectomy, and were analyzed histologically and immunohistochemically. Results Ophthalmological signs of IONHL included decrease visual acuity, red eye, aqueous flare; keratic precipitates (Kp), vitreous opacity, retinal detachment and multiple whiteyellow retinal lesions of different sizes and fuzzy boundaries. IONHL patients were always misdiagnosed as diverse and nonspecific symptoms and signs, two cases were misdiagnosed as retinitis or chorioiditis, one case as intermediate uveitis, one case as secondary glaucoma in uveitis. The duration from onset of symptom and sign to a final diagnosis was from 6 months to 24 months with an average of 13.3 months. Conclusions The clinical manifestation of IONHL was diverse and non-specific，and this disease was unknown to lots of doctors and easily be misdiagnosed.
Objective To analyze the results of diagnostic pars plana vitrectomy (PPV) in patients with uveitis of unknown cause. Methods This is a retrospective case series study. Sixty-five patients (67 eyes) with uveitis of unknown cause were enrolled in this study. There were 31 males (32 eyes) and 34 females (35 eyes). The ages were from 6 to 84 years, with the mean age of (55.00±18.56) years. All eyes were received PPV. Examination of vitreous samples consisted of microbial stains and culture, microbial DNA and antibody detection, cytokine measurement, cytology, flow cytometry and gene rearrangement detection. Results Vitreous analysis was positive in 40 of 67 eyes (59.7%). Positive results indicated bacterial endophthalmitis in 20 of 40 eyes (50.0%), lymphoma in 11 eyes (27.5%), viral IgM and IgG increased significantly in 3 eyes (7.5%), fungal endophthalmitis in 3 eyes (7.5%), IgG of toxocara increased significantly in 2 eyes (5.0%), IgG of toxoplasma Gondii increased significantly in 1 eye (2.5%). Conclusion The diagnostic yield of vitreous samples in uveitis eyes of unknown cause is 59.7%.
ObjectiveTo study the clinical and pathological characteristics and imaging manifestations of pulmonary mucosa associated lymphoid tissue (MALT) lymphoma.MethodsThe clinical and multidetector computed tomography (MDCT) imaging data of 17 patients with pathological proven pulmonary MALT lymphoma were reviewed retrospectively.ResultsThe MDCT manifestations were divided into 4 types: ① pneumonia/consolidation, ② mass/nodule type, ③ bronchovascular lymphatic type, ④ mixed type. The imaging features included air bronchiectasis in 13 cases and bronchiectasis in 9 cases. Multiple small pulmonary nodules were found in 11 cases, ground glass opacity in 9 cases, 4 cases of pleural effusion, pulmonary hilar and mediastinal lymph node enlargement in 3 cases. Among these 17 cases, 4 had extra-pulmonary involvement and 2 without obvious symptoms. The main clinical symptoms including cough, expectoration, dyspnea, fever, chest pain, hemoptysis, night sweats. The pathological manifestation is the infiltration of a large number of B lymphocytes and nuclear heterocells.ConclusionsThe clinical manifestations of pulmonary MALT lymphoma are not specific, but the progress is slow, and may be associated with autoimmune diseases. The main MDCT findings of pulmonary MALT lymphoma include consolidation, nodules or masses with air bronchogram. Lymph node enlargement is rare. Clinical diagnosis should also be based on pathological results.
ObjectiveTo analyze the influencing factors for hepatitis B virus (HBV) infection screening in lymphoma patients prior to chemotherapy with a focus on HBV reactivation after chemotherapy. MethodsThe HBV infection screening data of 449 patients with lymphoma treated by chemotherapy between June 2010 and July 2012 were analyzed retrospectively. ResultsAmong the 449 patients, 387 (86.2%) were screened for HBV before initiation of chemotherapy, and patients with elevated aminotransferase levels were more likely to receive pre-chemotherapy HBV testing (OR=2.509, P=0.040). HBV reactivation was observed in 16.1% (9/56) of the HBsAg-positive patients after chemotherapy, and it was more likely to occur in patients with the use of rituximab (29.2% vs. 6.3%; P=0.030). Prophylactic antiviral therapy can significantly reduce the incidence of chemotherapy-induced HBV reactivation (12.0% vs. 50.0%; P=0.046). Two cases of reactivation occurred in patients who were HBsAg negative and hepatitis B core antibody positive. ConclusionHBV reactivation, especially for people with the use of rituximab, is a common complication in patients with HBV infection. HBV infection testing should be considered for lymphoma patients who were planned for chemotherapy. Prophylactic antiviral therapy can greatly decrease the incidence of HBV reactivation.
ObjectiveTo improve the knowledge of primary tracheobronchial lymphoma.MethodsTwo patients with primary tracheobronchial lymphoma admitted to First Affiliated Hospital Guangxi Medical University in 2013 and in 2016 were analyzed retrospectively, and related literatures were reviewed. Chinese National Knowledge Infrastructure, Wanfang database and VIP database were searched by using " trachea lymphoma” or " bronchus lymphoma” as keywords. Meanwhile, databases including PubMed, Ovid Medline and Embase database were retrieved with " Trachea” or " Bronchus” AND " Lymphoma” as keywords. Seventy-two cases of primary tracheobronchial lymphoma were reported, the clinical feature, imaging feature, pathological feature, treatment and prognosis of 72 cases were analyzed.ResultsThe two patients were both females. The chief complaints included cough and dyspnea. The tissue biopsy under bronchoscope was the main diagnostic method. On histopathology, one case was diagnosed grade B cell lymphoma, another was diagnosed mantle cell lymphomas. After chemotherapy, the symptoms were relieved and never relapsed in the follow-up period until October 2016. Literature review found 72 patients with primary tracheobronchial lymphoma with women being the majority (47 cases, 65.28%). The patients aged from16 to 82 years with a median age of 51 years, and nine cases (12.5%) of the patients aged from 16 to 30 years. The specific clinical symptoms were cough and dyspnea. Pulmonary function prompted obstructive dysfunction of pulmonary ventilation. The chest CT scan showed consolidation shadow in trachea and bronchus with or without pulmonary atelectasis. Neoplasms could be found by bronchoscopy. Mucosa-associated lymphoid tissue (MALT) lymphoma was the most common pathological characteristic (36.11%). Mantle cell lymphomas has not been reported currently.ConclusionsPrimary tracheobronchial lymphoma is one of the rare airway tumors. Its clinical features, imaging examinations and bronchoscopic characteristics are not specific, which can be easily confused with lung cancer. It also can cause life-threatening airway obstruction. The bronchoscopy play an important role in diagnosis of primary tracheobronchial lymphoma, while the diagnosis is confirmed by histopathological examination. The main pathology type is MALT lymphoma. The prognosis is good.
ObjectiveTo evaluate the safety and efficacy of the intravitreal methotrexate treatment in patients with primary vitreoretinal lymphoma (PVRL). MethodsRetrospective non-comparative interventional case series. Fourteen patients (26 eyes) with biopsy-proven PVRL were included in the study. All patients received examination of Snellen chart visual acuity, fundus color photography and optical coherence tomography (OCT). Among the 24 eyes with recordable visual acuity, 17 eyes has initial visual acuity≥0.1 (0.45±0.20) and 7 eyes with initial visual acuity ranged from light perception to hand movement. The vitreous opacities and (or) subretinal yellowish-white lesions and retinal pigment epitheliumuplift were observed in all eyes. All eyes were treated with intravitreal methotrexate (4000 μg/ml, 0.1 ml) injections according to a induction-consolidation-maintenance regimen. For 26 treated eyes, each received an average of (11.5±6.3) injections. Twenty eyes had finished theintraocular chemotherapy, while 6 eyes had not. Eight of 20 eyes were clinically confirmed free of tumor cells by diagnostic vitrectomy, 12 eyes were still with tumor cell involvement.The follow-up was ranged from 2 to 48 months, the mean time was 18 months. The examination of BCVA, fundus color photography and OCT were performed. No tumor cell was defined as clinical remission. Visual acuity was scored as improved or declined obviously (improved or declined 2 lines) or mild improved or declined (changed within 2 lines). ResultsTwenty eyes achieved clinical remission after (3.5±3.6) injections, 12 eyes of 20 eyes with tumor cell involvement before chemotherapy achieved clinical remission after (5.8±3.0) injections. The mean visual acuity of seventeen eyes with initial visual acuity 0.1 in induction phase and at the end of treatment were 0.36±0.23 and 0.56±0.20, respectively. Compared with before treatment, the visual acuity was mild declined in induction phase (t=1.541, P>0.05), but mild improved at the end of treatment (t=2.639, P<0.05). The visual acuity at the end of treatment in 7 eyes with initial visual acuity<0.1 was ranged from no light perception to 0.1. Of 14 patients, 2 patients have been fatal because of brain lesions progression at 42 and 48 months after diagnosis of primary central nervous system lymphoma. No ocular recurrence was noted during the follow-up in 20 eyes who finished intraocular chemotherapy. ConclusionsPVRL patients can achieve clinical remission after (3.5±3.6) injections by intravitreal chemotherapy of methotrexate, and the visual acuity improved mildly. No ocular recurrence was found during follow-up.