Mediastinal fibrosis and Hodgkin lymphoma mimicking bronchiolitis obliterans organizing pneumonia.

Q4 Medicine
Pneumologia Pub Date : 2015-01-01
Ramona Elena Nedelcu, Emese Kiss, Mircea Ciorba, Paul Galbenu, Ruxandra Ulmeanu
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引用次数: 0

Abstract

Bronchiolitis obliterans organizing pneumonia (BOOP) represents a kaleidoscope of concepts and morphologies, often being confused with a series of conditions, among which the most feared are Hodgkin's lymphoma and bronchioloalveolar carcinoma. We shall present the case of a 56-year-old patient, diagnosed in August 2013 with a pulmonary tumour of the right upper lobe, which was CTstaged - T4N0M0 (IIIA), who underwent a video-assisted thoracotomy for histopathological confirmation. A mediastino-pulmonary formation had been detected intraoperatively and multiple biopsies had been collected. The information brought by the histopathological examination suggested the presence of 2 synchronous pathologies, namely: the mediastinal biopsy showed an advanced degree of dense, compact fibrosis and the pulmonary biopsy highlighted the presence of granulation tissue and Masson bodies in the distal airspace with destruction of vascular and alveolar structures, an aspect which was compatible with organizing pneumonia (BOOP). Once a diagnosis was established, an oral corticosteroid therapy was initiated (Prednisone 30 mg/day) over a period of one month, but the symptomatology of the patient worsened. A new thoracic CT carried out in November 2013 highlighted the progression and extension of the paramediastinal tumoral formation, exhibiting central necrosis and invading the mediastinal vessels, causing their compression (superior vena cava syndrome) associated with multiple mediastinal and hilar adenopathies. The non-favorable evolution and the extensive array of conditions that may mimic the BOOP histopathological pattern have been the key elements, which were the basis of our persistence in getting a real diagnosis. Therefore, in this respect, the biopsy parts performed by thoracotomy were sent for immunohistochemical testing. The CD30 and CD15 positive markers distinctive for Reed-Sternberg cells allowed the diagnosis of Hodgkin's lymphoma.

纵隔纤维化和霍奇金淋巴瘤模拟闭塞性细支气管炎组织肺炎。
闭塞性细支气管炎组织性肺炎(BOOP)是一个概念和形态学的万花筒,经常与一系列疾病混淆,其中最令人恐惧的是霍奇金淋巴瘤和细支气管肺泡癌。我们将介绍一位56岁的患者,于2013年8月被诊断为右上叶肺肿瘤,ct分期为T4N0M0 (IIIA),并接受了视频辅助开胸手术以进行组织病理学证实。术中发现纵隔-肺形成,并进行了多次活检。组织病理学检查提示存在2种同步病理,纵隔活检显示高度致密致密纤维化,肺活检显示远端空域存在肉芽组织和Masson小体,血管和肺泡结构破坏,与组织性肺炎(BOOP)相一致。一旦确诊,开始口服皮质类固醇治疗(强的松30毫克/天)一个月,但患者的症状恶化。2013年11月进行的新胸部CT显示了副纵隔肿瘤形成的进展和扩展,表现为中央坏死并侵入纵隔血管,导致其受压(上腔静脉综合征),并伴有多发性纵隔和肺门腺病。不利的进化和可能模仿BOOP组织病理模式的广泛条件是关键因素,这是我们坚持得到真正诊断的基础。因此,在这方面,通过开胸进行的活检部分被送去进行免疫组织化学检测。Reed-Sternberg细胞特有的CD30和CD15阳性标记物可用于霍奇金淋巴瘤的诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pneumologia
Pneumologia Medicine-Pulmonary and Respiratory Medicine
CiteScore
0.20
自引率
0.00%
发文量
10
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