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Pulmonary involvement in pediatric lymphoma
Katherine E Maturen1, Caroline E Blane, Peter J Strouse
1Department of Radiology, University of Michigan Health Systems, 1500 E. Medical Center Drive/F3505, Ann Arbor, MI 48109-0030, USA.
Insights
Pulmonary lymphoma is more common in children with Hodgkin disease (HD), non-Hodgkin lymphoma (NHL), and post-transplant lymphoproliferative disorder (PTLD) than previously thought. This 13% prevalence highlights the need for vigilance in diagnosing lung involvement in pediatric lymphoma patients.
Area of Science:
- Pediatric Oncology
- Pulmonary Medicine
- Radiology
Background:
- Pulmonary lymphoma prevalence in pediatric patients is not well-documented.
- Children with hematologic malignancies are at risk for extranodal disease.
- Early identification of pulmonary involvement is crucial for treatment.
Purpose of the Study:
- To determine the prevalence of pulmonary parenchymal lymphoma in children.
- To assess involvement in Hodgkin disease (HD), non-Hodgkin lymphoma (NHL), and post-transplant lymphoproliferative disorder (PTLD).
Main Methods:
- Retrospective analysis of 161 pediatric lymphoma patients over 10 years.
- Defined pulmonary lymphoma excluding isolated pleural or mediastinal disease.
- Utilized CT imaging findings for diagnosis.
Main Results:
- Overall pulmonary parenchymal lymphoma prevalence was 13% (21/161).
- Prevalence by subtype: 12% in HD, 10% in NHL, 29% in PTLD.
- Common CT findings included nodules (90%), masses (38%), and interstitial disease (9%).
Conclusions:
- Pediatric pulmonary lymphoma is more prevalent than expected, impacting patient management.
- New pulmonary lesions in lymphoma patients warrant suspicion, especially in immunocompromised individuals.
- Consider biopsy for lesions unresponsive to infection treatment to rule out lymphoma.
Background:
The prevalence of pulmonary lymphoma in the pediatric age group is not documented in the literature.
Objective:
This study was designed to assess the prevalence of pulmonary parenchymal lymphoma in children with Hodgkin disease (HD), non-Hodgkin lymphoma (NHL) and post-transplant lymphoproliferative disorder (PTLD).
Materials And Methods:
A 10-year retrospective analysis of 161 lymphoma patients (62 girls and 99 boys), mean age of 12.4 years, was performed. The definition of pulmonary lymphoma excluded those with isolated pleural disease and/or mediastinal adenopathy.
Results:
Eighty-two patients had HD, 65 had NHL, and 14 had PTLD. Overall prevalence of pulmonary parenchymal involvement was 13% (21/161), including 12% of patients with HD, 10% of patients with NHL, and 29% of patients with PTLD. CT findings included: pulmonary nodules (90%) or mass (38%); interstitial (9%) or alveolar (9%) disease; cavitation (9%); and pleural based mass (9%).
Conclusions:
Pulmonary parenchymal disease in our pediatric lymphoma population was more prevalent than expected (13%). This is significant for patient management. New pulmonary lesions in patients with known lymphoma should be regarded with suspicion. In the setting of immune suppression, pulmonary lesions treated as infection may actually represent lymphoma. Expeditious biopsy of lesions failing to respond promptly to antibiotic therapy should be considered.
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