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.
Primary vitreoretinal lymphoma (PVRL) is one of the most common type of primary intraocular lymphoma. The current treatment options include local ocular radiotherapy (radiotherapy), systemic chemotherapy (chemotherapy), local ocular chemotherapy, and combination therapy. The treatment options are different at different stages of PVRL, however, there is no uniform treatment guideline. Local ocular chemotherapy can make the drug reach effective therapeutic concentration in the eye, and it can be repeated many times. At the same time, it can avoid the adverse reactions caused by systemic medication or radiotherapy. It is an ideal choice for relieving ocular symptoms. At present, the mainstream ocular local chemotherapeutics are methotrexate (MTX) and rituximab (RTX). The basic consensus about the intravitreal injection of MTX (IVM) is the induction-consolidation-maintenance model, however, the time of each stage and frequency of IVM are diverse. The time interval of intravitreal injection of RTX is also variable, ranging from 1 time/week to 1 time/months and so on. Corneal epithelial lesions caused by frequent MTX injections and the higher recurrence rate after RTX treatment are the main reasons for changing the treatment plan. For patients with primary central nervous system lymphoma and PVRL, combined treatment with neurology department is necessary to save patient's lives, ophthalmology treatment relieves ocular symptoms and improves the patient's quality of life. For patients with PVRL alone without central nervous system involvement, ophthalmology treatment is necessary to control patient's eye symptoms, and close follow-up should be followed to find the involvement of the central nervous system in time, and then combined with neurological treatment to save patient’s lives.
ObjectiveTo investigate the clinical characteristics and prognosis of pneumocystis pneumonia (PCP) in patients with lymphoma. MethodsTwenty inpatients who were diagnosed as lymphoma with PCP in PLA 307 Hospital from March 2012 to December 2014 were retrospectively analyzed. ResultsAll patients got non-Hodgkin's lymphoma. Specific genes for Pneumocystis jirovecii were found in the sputum of 5 patients and the bronchoalveolar lavage fluid of the other 15 patients. The major clinical presentations were fever (18/20) and dyspnea (13/20). Arterial blood gas analysis showed that all patients had hypoxaemia. There were 10 patients with respiratory failure (10/20), in which 7 patients needed mechanical ventilation (7/20). Four patients died (4/20). All patients were treated by multiple chemotherapy. Fifteen patients (75%) had leukocytopenia, with an average white blood cell (WBC) count of (3.2±2.8)×109/L. The mean lactate dehydrogenase (LDH) level was (374.6±197.2) U/L. The mean APACHEⅡ score was 12.6±4.4. PCP had no significant manifestations under the bronchoscope. Imaging manifestations were ground-glass opacities expanding to periphery from the hila, but the pleura was less involved. Univariate analysis revealed that there were no significant differences in chemotherapy cycle, WBC count or G test between the survival group and the death group. However, serum LDH, APACHEⅡ score, delay diagnosis, and co-infection were statistically significant between the two groups. ConclusionsThe main clinical presentations of PCP patients with lymphoma are fever and progressive exertional dyspnea. High LDH, high APACHEⅡ score, diagnosis delay and co-infection indicate poor prognosis.
ObjectiveTo analyze the characteristics of ultrasound images for soft tissue lymphoma and discuss the diagnostic value of ultrasonography. MethodsBetween January 2008 and August 2014, the ultrasound images of 25 soft tissue lymphomas confirmed by histopathology and immunohistochemistry were retrospectively analyzed. ResultsOf the total 25 patients with soft tissue lymphoma (histological types of non-Hodgkin's lymphoma), there were 10 females and 15 males. Among them, 14 had diffuse large B-cell lymphoma (56%, 14/25). There was a primary lymphoma located in the lower leg, and all the rest 24 cases were secondary lymphoma. Of the 24 secondary cases, 19 presented solitary lesion located respectively in limbs (8 cases), trunk (7 cases) and head & neck (4 cases); the other 5 cases presented multiple lesions located respectively in limbs and trunk. Among all the lesions, 12 were located in muscular layer, presenting weak echo mass with irregular shape growing along the direction of muscular fibers; and 13 were located in skin and subcutaneous soft tissue, among which 4 cases showed diffused thickening of skin and subcutaneous layer with irregular hypoechoic areas on ultrasound examination, and 9 cases showed nodular or hypoechoic irregular shaped lesion, iso-hyperechoic, with heterogeneous internal echogenecity having unclear boundary. ConclusionUnderstanding the characteristics of soft tissue lymphoma on ultrasound images will help to improve diagnostic accuracy.
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.
Primary vitreoretinal lymphoma (PVRL) is a rare and aggressive high-grade non-Hodgkin lymphoma. PVRL always with non-specific symptoms and has therefore been called as masquerade syndrome. Thus, the early and correct diagnosis of PVRL is a difficulty. For PVRL, the imaging findings can be specific but variety, histological diagnosis is still the gold standard. Its diagnosis needs to be combined with clinical manifestations, imaging features, pathological diagnosis and molecular biology. With the advancement of technology, especially in the field of the cytokines detection and the gene expression profiling research, molecular biology diagnosis of PVRL is becoming a research hotspot and an important auxiliary diagnostic method.
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%.
Epstein-Barr (EB) virus infection is associated with various tumors of lymphoid and epithelial origin. EB virus exists in most humans as a latent infection. EB virus latent infection-related genes play a key role in the EB virus latent infection, and also play an important role in promoting the occurrence and development of related tumors. This article will briefly introduce the characteristics of EB virus latent infection, the protein coding genes and non-coding genes related to EB virus latent infection (including EB virus nuclear antigen genes, EB virus latent membrane protein genes, EB virus encoded small RNA genes and EB virus microRNA genes), and the main functional mechanism of these EB virus latent infection-related genes in EB virus latent infection and subsequent tumorigenesis. The purpose is to providea theoretical basis for a comprehensive understanding of the EB virus latent infection and the mechanism of tumors caused by EB virus.
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.
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.