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Granulomatosis after autologous stem cell transplantation in nonHodgkin lymphoma – experience of single institution and a review of literature

View Article: PubMed Central - PubMed

ABSTRACT

Background: Sarcoidosis before and after treatment of malignancy is an important differential diagnosis that has to be distinguished from lymphoma.

Patients and methods: Hodgkin lymphoma, diffuse large B-cell lymphoma and aggressive follicular lymphoma are being staged and treatment effect is evaluated with PET-CT. We report three cases of aggressive lymphoma after high dose therapy and autologous stem cell transplantation with positive lymph nodes on PET-CT, which were histologically diagnosed as sarcoidosis/granulomatosis. In the literature, we found that false positive lymph nodes were more common after allogeneic than after autologous transplantation.

Conclusions: Post-treatment PET-CT positive lymph nodes should always be examined histologically prior to any further treatment decision to avoid unnecessary toxic procedures.

No MeSH data available.


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PET-CT patient 2: Suspicious relapse in hilar lymph nodes.
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j_raon-2015-0033_fig_002: PET-CT patient 2: Suspicious relapse in hilar lymph nodes.

Mentions: In our observation through past few years, we found three different cases of pulmonary granulomatosis and sarcoidosis in lymphoma patients. All three patients were young females, aged between 33 and 40 years. Two of them had the primary mediastinal large B cell lymphoma and one had the diffuse large B-cell lymphoma. All three received standard first line immune-chemotherapy, relapsed and then following conventional salvage treatment underwent high dose treatment and autologous stem cell transplantation (AuSCT). All three had the control PET-CT scan 4-6 months following AuSCT (Figure 1, 2 and 3). Patient in Figure 1 had suspicious infiltrates in the lungs, paramediastinally and in the right pulmonary hilus. The thoracic X-ray was normal. The transbronchial biopsy showed granulomatosis and with bronchoalveolar lavage lymphocytic alveolitis with abnormal CD4/CD8 ratio was discovered. Therefore, the diagnosis of sarcoidosis was set and the patient initiated the corticosteroid therapy. Patient in Figure 2 had suspicious infiltrates on PET-CT paratracheally, below the carina, close to the aortic arcus, between the liver and thoracic wall, under the diaphragm, in the spleen, some lesions in the liver and in the mesenterium, nodular lesions in the lungs and in the left and right pulmonary hili. The X-ray revealed enlarged mediastinum due to the lymph nodes. The transbronchial biopsy showed granulomatosis and the bronchoalveolar lavage discovered lymphocytic alveolitis with abnormal CD4/CD8 ratio. A normal serum level of calcium and angiotensin converting enzyme was found in the blood. The corticosteroid therapy was initiated. Patient in Figure 3 had an enlarged mediastinum on the X-ray of the thorax and suspicious infiltrates on PET-CT in the neck region, paratracheally, behind the aortic arc, in the right and left pulmonary hili, subcarinally, between the pancreas and the stomach and beside the hepatic artery and inferior vena cava. The transbronchial biopsy showed granulomatose changes, yet alveolitis was not present and the serum concentrations of calcium and angiotensin converting enzyme were normal. The patient was observed and the corticosteroid therapy has not been initiated. At present, all three patients are under regular control and none of them relapsed with lymphoma for the second time between 6 and 46 months following AuSCT. None of our patients complained of any symptoms of systemic sarcoidosis like the two cases described below.12,13Figure 1


Granulomatosis after autologous stem cell transplantation in nonHodgkin lymphoma – experience of single institution and a review of literature
PET-CT patient 2: Suspicious relapse in hilar lymph nodes.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5120571&req=5

j_raon-2015-0033_fig_002: PET-CT patient 2: Suspicious relapse in hilar lymph nodes.
Mentions: In our observation through past few years, we found three different cases of pulmonary granulomatosis and sarcoidosis in lymphoma patients. All three patients were young females, aged between 33 and 40 years. Two of them had the primary mediastinal large B cell lymphoma and one had the diffuse large B-cell lymphoma. All three received standard first line immune-chemotherapy, relapsed and then following conventional salvage treatment underwent high dose treatment and autologous stem cell transplantation (AuSCT). All three had the control PET-CT scan 4-6 months following AuSCT (Figure 1, 2 and 3). Patient in Figure 1 had suspicious infiltrates in the lungs, paramediastinally and in the right pulmonary hilus. The thoracic X-ray was normal. The transbronchial biopsy showed granulomatosis and with bronchoalveolar lavage lymphocytic alveolitis with abnormal CD4/CD8 ratio was discovered. Therefore, the diagnosis of sarcoidosis was set and the patient initiated the corticosteroid therapy. Patient in Figure 2 had suspicious infiltrates on PET-CT paratracheally, below the carina, close to the aortic arcus, between the liver and thoracic wall, under the diaphragm, in the spleen, some lesions in the liver and in the mesenterium, nodular lesions in the lungs and in the left and right pulmonary hili. The X-ray revealed enlarged mediastinum due to the lymph nodes. The transbronchial biopsy showed granulomatosis and the bronchoalveolar lavage discovered lymphocytic alveolitis with abnormal CD4/CD8 ratio. A normal serum level of calcium and angiotensin converting enzyme was found in the blood. The corticosteroid therapy was initiated. Patient in Figure 3 had an enlarged mediastinum on the X-ray of the thorax and suspicious infiltrates on PET-CT in the neck region, paratracheally, behind the aortic arc, in the right and left pulmonary hili, subcarinally, between the pancreas and the stomach and beside the hepatic artery and inferior vena cava. The transbronchial biopsy showed granulomatose changes, yet alveolitis was not present and the serum concentrations of calcium and angiotensin converting enzyme were normal. The patient was observed and the corticosteroid therapy has not been initiated. At present, all three patients are under regular control and none of them relapsed with lymphoma for the second time between 6 and 46 months following AuSCT. None of our patients complained of any symptoms of systemic sarcoidosis like the two cases described below.12,13Figure 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Sarcoidosis before and after treatment of malignancy is an important differential diagnosis that has to be distinguished from lymphoma.

Patients and methods: Hodgkin lymphoma, diffuse large B-cell lymphoma and aggressive follicular lymphoma are being staged and treatment effect is evaluated with PET-CT. We report three cases of aggressive lymphoma after high dose therapy and autologous stem cell transplantation with positive lymph nodes on PET-CT, which were histologically diagnosed as sarcoidosis/granulomatosis. In the literature, we found that false positive lymph nodes were more common after allogeneic than after autologous transplantation.

Conclusions: Post-treatment PET-CT positive lymph nodes should always be examined histologically prior to any further treatment decision to avoid unnecessary toxic procedures.

No MeSH data available.


Related in: MedlinePlus