Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2013.036
Autopsy and Case Reports
Article / Autopsy Case Report

Primary diffuse large B-cell lymphoma or lymphomatoid granulomatosis grade 3: a still-puzzling diagnosis in autopsy

Fernando Peixoto Ferraz de Campos; Aloísio Felipe-Silva; Maria Claudia Nogueira Zerbini; João Augusto dos Santos Martines

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Abstract

Primary lung lymphoma is a rare entity accounting for approximately 0.3% of all primary neoplasia of the lung and includes diffuse large B-cell lymphoma (DLBL) and lymphomatoid granulomatosis (LYG). Considering that clinical features may be similar, whereas epidemiology, morphology, and radiological features are different, the authors report a case of a middle-aged man who presented multiple pulmonary nodules in the lower lobes and ground-glass opacities scattered bilaterally on computed tomography. Clinically, he presented a consumptive syndrome with respiratory failure and pleurisy, which progressed until death. The autopsy findings were consistent with lymphomatoid granulomatosis (LYG) grade 3/ diffuse large B-cell lymphoma (DLBL). The authors call attention to the difficulty of establishing an accurate diagnosis, mainly when the demonstration of EBV-infected atypical B-cells fails.
 

Keywords

Lung, Lymphoproliferative Disorders, Respiratory Insufficiency, Autopsy

References

Colby TV, Yousem SA. Pulmonary histology for the surgical pathologist. Am J Surg Pathol. 1988;12:223-9. http://dx.doi.org/ [https://doi.org/10.1097/00000478-198803000-00008].

William J, Variakojis D, Yeldandi A, Raparia K. Lymphoproliferative Neoplasms of the Lung. A Review. Arch Pathol Lab Med. 2013;137:382-91. http://dx.doi.org/ [https://doi.org/10.5858/arpa.2012-0202-RA].

Burke JS. Are there site-specific differences among MALT lymphomas - morphologic, clinical? Am J Clin Pathol. 1999;111:S133-43.

L’Hoste RJ Jr, Fillipa DA, Lieberman PH, Bretsky S. Primary pulmonary lymphomas. A clinicopathologic analysis of 36 cases. Cancer. 1984;54:1397-406. http://dx.doi.org/ [https://doi.org/10.1002/1097-0142(19841001)54:7<1397:AID-CNCR2820540728>3.0.CO;2-4].

Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J. 2002;20:750-62. http://dx.doi.org/ [https://doi.org/10.1183/09031936.02.00404102].

Rush WL, Andriko JA, Taubenberger JK, et al. Primary anaplastic large cell lymphoma of the lung: a clinicopathologic study of five patients. Mod Pathol. 2000;13:1285-92. http://dx.doi.org/ [https://doi.org/10.1038/modpathol.3880235].

Graham BB, Mathisen DJ, Mark EJ, Takvorian RW. Primary pulmonary lymphoma. Ann Thorac Surg. 200- 5;80:1248-53.

Ferraro P, Trastek VF, Adlakha H, Deschamps C, Allen MS, Pairolero PC. Primary non-Hodgkin’s lymphoma of the lung. Ann Thorac Surg. 2000;69:993-7. http://dx.doi.org/ [https://doi.org/10.1016/S0003-4975(99)01535-0].

Kim JH, Lee SH, Park J, et al. Primary pulmonary non-Hodgkin’s lymphoma. Jpn J Clin Oncol. 2004;34:510-4. http://dx.doi.org/ [https://doi.org/10.1093/jjco/hyh095].

Cordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas: a clinical study of 70 cases in nonimmunocompromised patients. Chest. 1993;103:201-8. http://dx.doi.org/ [https://doi.org/10.1378/chest.103.1.201].

Li G, Hansmann ML, Zwingers T, Lennert K. Primary lymphomas of the lung: morphological, immunohistochemical and clinical features. Histopathology. 1990;16:519-31. http://dx.doi.org/ [https://doi.org/10.1111/j.1365-2559.1990.tb01157.x].

Neri N, Jesus Nambo M, Aviles A. Diffuse large B-cell lymphoma primary of lung. Hematology. 2011;16:110-2. http://dx.doi.org/ [https://doi.org/10.1179/102453311X12940641877722].

Boone JM, Zhang D, Fan F. Lymphomatoid Granulomatosis: a case report with unique clinical and histopathologic features. Ann Clin Lab Sci. 2013;43:181-5.

Rooper L, Gocke CD, Belchis DA. Pleural fluid cytology of the polymorphous variant of EBV-positive diffuse large B-cell lymphoma: first report and distinction from a reactive process. Case Rep Pathol. 2013. Epub 2013 Sep 3. http://dx.doi.org/ [https://doi.org/10.1155/2013/450279]10.1155/2013/450279

Ridene I, Radhouani I, Ayadi A, et al. Imagerie des lymphomes pulmonaires primitifs. Rev Mal Respir. 2010;27:1069-76. http://dx.doi.org/ [https://doi.org/10.1016/j.rmr.2010.09.011].

Ooi GC, Chim CS, Lie AK, Tsang KW. Computed tomography features of primary pulmonary non-Hodgkin’s lymphoma. Clin Radiol. 1999;54:438-43. http://dx.doi.org/ [https://doi.org/10.1016/S0009-9260(99)90828-0].

Ogata-Suetsugu S, Maeyama T, Takeshita M, et al. A case of diffuse large B-cell lymphoma of the lung demonstrating diffuse ground-glass shadows. Ann Thorac cardivasc Surg. 2011;17:591-4. http://dx.doi.org/ [https://doi.org/10.5761/atcs.cr.10.01651]10.5761/atcs.cr.10.01651

Liebow AA, Carrington CRB, Friedman PJ. Lymphomatoid granulomatosis. Human Pathol.1972;3:457:558.

Katzenstein ALA, Doxtader E, Narendra S. Lymphomatoid granulomatosis. Insight gained over 4 decades. Am J Surg Pathol. 2010;34:e35-48. http://dx.doi.org/ [https://doi.org/10.1097/PAS.0b013e3181fd8781].

Morice WG, Kurtin PJ, Myers JL. Expression of cytolitic lymphocyte-associated antigens in pulmonary lymphomatoid granulomatosis. Am J Clin Pathol. 2002;118:391-8. http://dx.doi.org/ [https://doi.org/10.1309/PMR7-7XLY-F10U-4V1Q].

Katzenstein AL, Peiper SC. Detection of Epstein-Barr virus genomes in lymphomatoid granulomatosis: analysis of 29 cases by the polymerase chain reaction technique. Mod Pathol. 1990;3:435-41.

Myers JL, Kurtin PJ, Katzenstein A-LA, et al. Lymphomatoid granulomatosis. Evidence of immunophenotypic diversity and relationship to Epstein-Barr virus infection. Am J Surg Pathol. 1995;19:1300-12. http://dx.doi.org/ [https://doi.org/10.1097/00000478-199511000-00011].

Nicholson AG, Wotherspoon AC, Diss TC, et al. Lymphomatoid granulomatosis: evidence that some cases represent Epstein-Barrvirus-associated B-cell lymphoma. Histopathology. 1996;29:317-24. http://dx.doi.org/ [https://doi.org/10.1111/j.1365-2559.1996.tb01415.x].

Taniere PH, Thivolet-Bejui F, Vitrey D, et al. Lymphomatoid granulomatosis Fa report on four cases: evidence for B phenotype of the tumoral cells. Eur Respir J. 1998;12:102-6. http://dx.doi.org/ [https://doi.org/10.1183/09031936.98.12010102].

Guinee D Jr, Jaffe E, Kingma D, et al. Pulmonary lymphomatoid granulomatosis. Evidence for a proliferation of Epstein-Barr virus infected B-lymphocytes with a prominent T-cell component and vasculitis. Am J Surg Pathol. 1994;18:753-64. http://dx.doi.org/ [https://doi.org/10.1097/00000478-199408000-00001].

Colby TV. Current histological diagnosis of lymphomatoid granulomatosis. Mod Pathol. 2012;25:S39-42. http://dx.doi.org/ [https://doi.org/10.1038/modpathol.2011.149].

Pitaluga S, Wilson WH, Jaffe ES. Lymphomatoid granulomatosis. In: Swerdlow SH, Campo E, Harris NL, et al., editors. WHO Classification of Tumors of Haematopoietic and Lymphoid Tisssues. Lyon: ARC; 2008. p. 247-9.

Katzenstein AL, Carrington CB, Liebow AA. Lymphomatoid granulomatosis: a clinicopathologic study of 152 cases. Cancer. 1979;43:360-73. http://dx.doi.org/ [https://doi.org/10.1002/1097-0142(197901)43:1<360:AID-CNCR2820430151>3.0.CO;2-8].

Bragg DG, Chor PJ, Murray KA, Kjeldsberg CR. Lymphoproliferative disorders of the lung:histopathology, clinical manifestations, and imaging features. AJR. 1994;163:273-81. http://dx.doi.org/ [https://doi.org/10.2214/ajr.163.2.8037014].

Lee JS, Tuder R, Lynch DA. Lymphomatoid Granulomatosis: Radiologic features and pathologic correlations. AJR. 2000;175:1335-9. http://dx.doi.org/ [https://doi.org/10.2214/ajr.175.5.1751335].

Chung JH, Wu CC, Gilman MD, et al. Lymphomatoid granulomatosis: CT and FDG-PET findings. Korean J Radiol. 2011;12:671-8. http://dx.doi.org/ [https://doi.org/10.3348/kjr.2011.12.6.671].

Vahid B, Salerno DA, Marik PE. Lymphomatoid granulomatosis: a rare cause of multiple pulmonary nodules. Respir Care. 2008;53:1227-9.

Karabag T, Aydin M, Barut F, et al. Epicardial mass causing cardiac compression. An unusual involvement in lymphomatoid granulomatosis. Tex Heart Inst J. 2012;39:116-8.

Zhang YX, Ding MP, Zhang T, et al. Lymphomatoid granulomatosis with CNS involvement can lead to spontaneous remission: case study. CNS Neurosci Ther. 2013;19:536-8. http://dx.doi.org/ [https://doi.org/10.1111/cns.12109].

Wilson WH, Kingma DW, Raffeld M, Wittes RE, Jaffe ES. Association of lymphomatoid granulomatosis with Epstein-Barr viral infection of B lymphocytes and response to interferon-alpha 2b. Blood. 1996;87:4531-7.

Makol A, Kosuri K, Tamkus D, De M, Calaca W, Chang HT. Lymphomatoid granulomatosis masquerading as interstitial pneumonia in a 66-year-old man: a case report and review ofliterature. J Hematol Oncol. 2009;2:39-44. http://dx.doi.org/ [https://doi.org/10.1186/1756-8722-2-39].

Jordan K, Grothey A, Grothe W, Kegel T, Wolf HH, Schmoll HJ. Successful treatment of mediastinal lymphomatoid granulomatosis with rituximab monotherapy. Eur J Haematol. 2005;74:263-6. http://dx.doi.org/ [https://doi.org/10.1111/j.1600-0609.2004.00367.x].

Aoki T, Harada Y, Matsubara E. Long-term remission after multiple relapses in an elderly patient with lymphomatoid granulomatosis after rituximab and high-dose cytarabine chemotherapy without stem-cell transplantation. J Clin Oncol. 2013;31:e390-3. http://dx.doi.org/ [https://doi.org/10.1200/JCO.2012.47.4999].

Siegloch K, Schmitz N, Wu HS, et al. Hematopoietic stem cell transplantation in patients with lymphomatoid granulomatosis: a European group for blood and marrow transplantation report. Biol Blood Marrow Transplant. 2013;19:1522-5. http://dx.doi.org/ [https://doi.org/10.1016/j.bbmt.2013.07.023].


 


Publication date:
01/13/2016

569696ac64cc8b5cda711bdb autopsy Articles

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