Bronchiolo-alveolar carcinoma in angio-immunoblastic lymphadenopathy

A 78-year-old woman presented progressive weakness of three months' duration and generalized lymphadenopathy. Lymph-node biopsy histopathology was diagnosed as immunoblastic lymphadenopathy. As the patient's condition was deteriorating rapidly, she was given corticosteroid with clinical improvement. Initially no distinct radiographic abnormalities of the lungs were seen however, a subsequent solitary nodule in the left lung base was detected. Histology showed a bronchiolo-alveolar carcinoma. Pulmonary parenchymal involvement in angioimmunoblastic lymphadenopathy (A.I.L.) has been previously well documented and radiographic abnormalities usually consist of well-circumscribed parenchymal infiltrates. The possibility of a development of bronchiolo-alveolar carcinoma in A.I.L. may be the consequence of a deficiency of the cellular immunity aggravated in part by an immunosuppressive treatment. The hypothesis of the paraneoplastic nature of A.I.L. has also been raised. There are, therefore, always compulsory reasons to check the nature of the pulmonary involvement.