Pulmonary Non-Hodgkin’s Lymphoma in AIDS: Outcome

12 Jan

Pulmonary involvement with non-Hodgkins lymphoma is relatively uncommon. Several series have described the radiographic manifestations of pulmonary involvement in non-AIDS lymphoma patients. In a retrospective review of non-Hodgkins lymphoma in 86 patients without AIDS, 19 percent had chest radiographic abnormalities, 9 percent of whom had pulmonary parenchymal involvement and 13 percent of whom had paratracheal, mediastinal or hilar adenopathy. Filley et al reported 136 patients with non-Hodgkins lymphoma and found 43 percent with radiographic evidence of intrathoracic disease; 4 percent had pulmonary parenchymal involvement. Enlargement of a single lymph node as the only manifestation of intrathoracic lymphoma was found in 40 percent of those patients with intrathoracic disease. Jenkins et al found pulmonary involvement in 25 percent of 81 patients with non-Hodgkins lymphoma. Chest roentgenograms showed nodules in four patients, infiltrates in nine, and single or multiple, rounded opacities in seven patients.

Previous studies in AIDS patients have not commented specifically on the radiographic and clinical manifestations of pulmonary lymphoma. Review of five published series of non-Hodgkins lymphoma in AIDS patients showed that pulmonary involvement occurred in only eight of 119 (6.7 percent) cases. Ten percent (four of 40) of Colorado patients and 17 percent (four of 24) of patients reported by Sourour and colleagues had pulmonary involvement. It is possible that these percentages represent an underestimate of the extent of pulmonary involvement given the lack of serial chest roentgenograms and autopsy findings in all series. starlix medication
In our series, chest roentgenograms revealed multiple nodules in three patients and diffuse interstitial infiltrates in one patient. Multiple nodules on chest roentgenograms in AIDS patients are not specific to non-Hodgkins lymphoma, since nodular patterns have been described with P carinii pneumonia and Kaposi’s sarcoma. All four of our patients had radiographic evidence of pulmonary involvement at the time of presentation of lymphoma. In contrast to nonAIDS lymphoma, intrathoracic lymphadenopathy was not seen in our patients.