Chest HRCT findings in acute transformation of adult T-cell lymphoma/leukemia

Centrilobular nodules are predictive chest computed tomography (CT) findings related to adult T-cell leukemia/lymphoma development in human T-lymphotropic virus type I carriers

AIM

To evaluate predictive chest computed tomography (CT) findings associated with the development of adult T-cell leukemia/lymphoma (ATLL) in human T-lymphotropic virus type I (HTLV-1) carriers.

MATERIALS AND METHODS

This retrospective study examined 171 adult T-cell leukemia/lymphoma and 158 HTLV-1 carriers who were treated from November 2004 to April 2021. The radiological features of 888 chest CT scans in total were retrospectively assessed by two chest radiologists who were unaware of the underlying diagnoses and compared between the groups.

RESULTS

In patients with aggressive type ATLL (acute type and lymphoma type), lymph node enlargement was the most frequently observed abnormality (65.2%), followed by ground-glass opacity (33.3%) and pleural effusion (30.4%). In patients with indolent type (chronic type and smoldering type), lymph node enlargement, and bronchiectasis were the most frequently observed abnormalities (5.6% and 5.6%, respectively). In each type, centrilobular nodules were observed in none and in one patient, respectively. In the 158 HTLV-1 carriers, centrilobular nodules (n = 62; 39.2%) were the most frequently observed abnormality. Centrilobular nodules were significantly frequently observed in HTLV-1 carriers compared with ATLL patients. No HTLV-1 carrier with centrilobular nodules on CT developed ATLL during the duration of care. A comparative analysis between CT scans performed before ATLL development in ATLL patients and those of HTLV-1 carriers showed that no centrilobular nodules were observed on the pre-ATLL CT scans, and a statistically-significant difference in centrilobular nodules was found between these two groups.

CONCLUSION

The presence of centrilobular nodules may be an indicative CT finding in HTLV-1 carriers who are less likely to develop ATLL.

Differential diagnosis of infectious diseases, drug-induced lung injury, and pulmonary infiltration due to underlying malignancy in patients with hematological malignancy using HRCT

PURPOSE

To differentiate among infectious diseases, drug-induced lung injury (DILI) and pulmonary infiltration due to underlying malignancy (PIUM) based on high-resolution computed tomographic (HRCT) findings from patients with hematological malignancies who underwent chemotherapy or hematopoietic stem cell transplantation.

MATERIALS AND METHODS

A total of 221 immunocompromised patients with hematological malignancies who had proven chest complications (141 patients with infectious diseases, 24 with DILI and 56 with PIUM) were included. Two chest radiologists evaluated the HRCT findings, including ground-glass opacity, consolidation, nodules, and thickening of bronchovascular bundles (BVBs) and interlobular septa (ILS). After comparing these CT findings among the three groups using the χ2test, multiple logistic regression analyses (infectious vs noninfectious diseases, DILI vs non-DILI, and PIUM vs non-PIUM) were performed to detect useful indicators for differentiation.

RESULTS

Significant differences were detected in many HRCT findings by the χ2 test. The results from the multiple logistic regression analyses identified several indicators: nodules without a perilymphatic distribution [p = 0.012, odds ratio (95% confidence interval): 4.464 (1.355-11.904)], nodules with a tree-in-bud pattern [p = 0.011, 8.364 (1.637-42.741)], and the absence of ILS thickening[p = 0.003, 3.621 (1.565-8.381)] for infectious diseases, the presence of ILS thickening [p = 0.001, 7.166 (2.343-21.915)] for DILI, and nodules with a perilymphatic distribution [p = 0.011, 4.256 (1.397-12.961)] and lymph node enlargement (p = 0.008, 3.420 (1.385-8.441)] for PIUM.

CONCLUSION

ILS thickening, nodules with a perilymphatic distribution, tree-in-bud pattern, and lymph node enlargement could be useful indicators for differentiating among infectious diseases, DILI, and PIUM in patients with hematological malignancies.

Rapidly progressing primary pulmonary lymphoma masquerading as lung infectious disease: A case report and review of the literature

BACKGROUND

Primary anaplastic large cell lymphoma of the lung represents a diagnostic challenge due to diverse manifestations and non-specific radiological findings, particularly in cases that lack extra-pulmonary manifestations and lung biopsy.

CASE SUMMARY

A 40-year-old woman presented with a 6-d history of fever, dry coughing, and dyspnea. Her white blood cell count was 20100/mm3 with 90% neutrophils. PaO2 was 60 mmHg and SaO2 was 90% when breathing ambient air. Chest computed tomography (CT) identified a solid nodule, 15 mm in diameter, with a poorly defined boundary in the upper right lung, and several smaller solid nodules throughout both lungs. Pulmonary artery CT and subsequent bedside X-ray showed diffuse patchy shadows throughout both lungs. Repeated cultures of blood samples and alveolar lavage failed to identify any pathogen. Due to the mismatch between clinical and imaging features, we conducted a bone marrow biopsy, and the results showed proliferation along all three lineages but no atypical or malignant cells. The patient received empirical antibacterial, antiviral, and antifungal treatments, as well as corticosteroids. The patient's condition deteriorated rapidly despite treatment. The patient died 6 d after hospitalization due to respiratory failure. Post-mortem lung biopsy failed to show inflammation but identified widespread infiltration of alveolar septum by anaplastic lymphoma kinase (ALK)-positive anaplastic cells.

CONCLUSION

ALK-positive anaplastic large cell lymphoma could present as a primary pulmonary disease without extra-pulmonary manifestations.

High prevalence of pulmonary findings in computed tomographies of HTLV-1-infected patients with and without adult-T cell leukemia/lymphoma - implications for staging

Lung involvement has been reported in HTLV-1 carriers and in patients with ATLL. Whether there are differences in the pattern of lung involvement between ATLL and HTLV carriers in North American patients is unknown. We aimed to compare CT pulmonary findings among patients with HTLV-1 infection with and without ATLL. Among 140 patients with HTLV-1 diagnosis, 97 had CT chest available. Of these, 72 (74.2%) had ATLL and 25 (25.8%) did not have ATLL. CT chest abnormalities were present in 90 (92.8%) participants (94.4% in ATLL; 88% in non-ATLL). Higher rates of lymphadenopathy (69.4% versus 24%, p < .01) and lower rates of bronchiectasis (25% versus 48%, p = .04) were seen in ATLL compared to non-ATLL. Our study supports that staging of lung involvement in ATLL should consider HTLV-associated pulmonary findings as not all CT chest abnormalities necessarily represent malignant infiltration.

Thoracic manifestations of adult T-cell leukemia/lymphoma on chest CT: difference between clinical subtypes

PURPOSE

We aimed to evaluate thoracic computed tomography (CT) findings in adult T-cell leukemia/lymphoma (ATL) and their differences among clinical subtypes.

METHODS

Thoracic CT scans of 49 ATL patients were retrospectively reviewed. On CT scans, the presence of lung parenchymal abnormalities (10 patterns), enlarged lymph nodes, pleural and pericardial effusions, and subcutaneous nodules was evaluated by two radiologists in cooperation. According to the Shimoyama criteria, the patients were divided into aggressive ATL group (n=28, acute and lymphoma types) and indolent ATL group (n=21, chronic and smoldering types). Differences in the prevalence of the CT findings between the two groups were examined. In the indolent ATL group, CT scans of 10 patients who eventually underwent transformation to aggressive ATL were also evaluated.

RESULTS

In aggressive ATL, enlarged lymph nodes (68%) was the most frequently observed finding. Several patterns of lung abnormalities were observed, such as ground-glass attenuation (36%), bronchial wall thickening (32%), nodules (29%), and centrilobular opacities (29%). In indolent ATL, enlarged lymph nodules (24%) and bronchiectasis (24%) were relatively frequently detected. Overall, the incidence of abnormal findings was higher in aggressive than in indolent ATL, except for bronchiectasis. Patients with transformation to aggressive ATL frequently demonstrated enlarged lymph nodes (80%).

CONCLUSION

On thoracic CT, enlarged lymph nodes and various lung and airway abnormalities, such as ground-glass attenuation and bronchial wall thickening, were observed in ATL patients, particularly those with aggressive ATL. Bronchiectasis was similarly found in patients with indolent ATL and aggressive ATL.