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THE FOLLOWING IS A BRIEF REVIEW OF THE RADIOLOGICAL PRESENTATIONS AND PATHOLOGIC CRITERIA OF ANAPLASTIC LYMPHOMA

PRINCIPAL ASPECTS DISCUSSED AT THE TELECONFERENCE ARE SUMMARIZED

1-GENERALITY

Found primarily in children more than 3 years of age with a peak incidence from 8 to 14 years. More than 95% of children with Pulmonary lymphomas have lymph node enlargement as a presenting sign.

Sometimes:
– tonsilar hypertrophy
– adenoidal hyperplasia
– pulmonary hilar enlargement
– splenomegaly
– bone pain
– unexplained fever
– anemia
– infiltrative skin lesions
– rarely CNS symptoms
acute or subacute bilateral alveolar infiltrate may be a rare presentation

2 – CHEST XRAY MANIFESTATIONS

2.1 – introduction
Large and small lymphocytic forms differ:
large – predominantly mediastinal and hilar enlargement
small – pleuropulmonary involvement

in Burgener, Hamlin AJR 1981:
large forms may invole lung parenchyma in half of the cases (n=56/112).
Of these 56 patients:
28/56 (50%) mediastinal node enlargement
19/56 (34%) hilar node enlargement
22/56 (40%) pulmonary involvement
20/56 (36%) pleural involvement

2.2-mediastinal enlargement +++

– ANTERIOR UPPER MEDIASTINUM MOST OFTEN INVOLVED
– MIDDLE MORE OFTEN INVOLVED BY A LYMPHADENOPATHY
– POSTERIOR, if extension.

2.3 – pulmonary involvement ++

2.3.1 – mass like +/- adenopathy

2.3.2 – diffuse reticulonodular patterns
14/56 (26%) Burgener, Hamelin AJR 1981
13/27 Balikian, Herman radiology 1979
pediatrics 1 case report Sherman Pediatrics 1997

sometime septal lines like lymphangitic carcinoma
LIP like 2 cases Valeyre Presse med 1985

2.3.3 – nodular
f
requent for some authors but with CT Lewis et al. AJR 1991
often not shown on CXR

2.3.4 – miliary rare

2.3.5 – pleural effusion transgression of fissures and pleura
20/56(20%) Burgener, Hamelin AJR 1981
16/138(12%) Koss et al Hum pathol 1983
26/200(13%) Xaubet et al Eur J Resp Dis 1985

2.3.6 – pericardial effusion
from medistinal nodes Kreel clin radiol 1962

2.3.7 – cavitation uncommun

2.3.8 – adenopathies frequently associated

2.3.9 – ARDS
In a case report, a 12 yo patient, had fever, cervical nodes enlargement, hepatosplenomegaly, interstitial infiltrates and rapidly respiratory failure with evidence of an ARDS Sherman J Pediatr 1997.

ARDS has multiple causes including
– infectious agents
– inhalation of toxic gases or other toxic compounds
– AI disorders
– various drugs that produce lung injury through a HS reaction
and certain malignant diseases in which the acute lung injury appears to be cytokine mediated Reynaldo et al. N Engl J Med 1982

2.3.10 – BOOP like
case report Safadi et al. Leuk Lymphoma 1997

2.3.11 – Lymphoma arising in cryptogenic fibrosing alveolitis
Orchad et al. Thorax 1998

2.3.12 – parenchymal consolidation not so rare
simulating acute airspace pneumonia from segmental to whole lobe or entire lung
Baron AJR 1961, Robbins cancer 1953
alveolar form present either as a primary lesion of the lung or a part of a disseminated disease Robins cancer 1953, Garrison mayo clin proc 1969


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