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Souza CA, Gomes MM, Gupta A. Pleural Malignancy-Challenges in Diagnosis and Multidisciplinary Approach. Semin Roentgenol 2023; 58:420-430. [PMID: 37973271 DOI: 10.1053/j.ro.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/16/2023] [Accepted: 07/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Carolina A Souza
- Division of Cardiothoracic Radiology, Department of Medical Imaging, The Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, Canada.
| | - Marcio M Gomes
- Department of Pathology & Laboratory Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada, 501 Smyth Road. Ottawa, Ontario, Canada
| | - Ashish Gupta
- Division of Cardiothoracic Radiology, Department of Medical Imaging, The Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, Canada
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Higuchi T, Matsuo K, Hashida Y, Kitahata K, Ujihara T, Taniguchi A, Yoshie O, Nakayama T, Daibata M. Epstein-Barr virus-positive pyothorax-associated lymphoma expresses CCL17 and CCL22 chemokines that attract CCR4-expressing regulatory T cells. Cancer Lett 2019; 453:184-192. [PMID: 30953706 DOI: 10.1016/j.canlet.2019.03.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 12/27/2022]
Abstract
Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphomas associated with chronic inflammation (DLBCL-CI) develop in patients with chronic inflammation but without any predisposing immunodeficiency. Given the expression of the EBV latent genes, DLBCL-CI should have mechanisms for evasion of host antitumor immunity. EBV-positive pyothorax-associated lymphoma (PAL) is a prototype of DLBCL-CI and may provide a valuable model for the study of immune evasion by DLBCL-CI. This study demonstrates that PAL cell lines express and secrete CCL17 and/or CCL22 chemokines, the ligands of C-C motif chemokine receptor 4 (CCR4), in contrast to EBV-negative DLBCL cell lines. Accordingly, culture supernatants of PAL cell lines efficiently attracted CCR4-positive regulatory T (Treg) cells in human peripheral blood mononuclear cells. PAL cells injected into mice also attracted CCR4-expressing Treg cells. Furthermore, this study confirmed that CCR4-expressing Treg cells were abundantly present in primary PAL tissues. Collectively, these findings provide new insight into the mechanisms of immune evasion by PAL, and further studies are warranted on whether such mechanisms eventually lead to the development of DLBCL-CI.
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Affiliation(s)
- Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Kazuhiko Matsuo
- Division of Chemotherapy, Kindai University Faculty of Pharmacy, Higashi-Osaka, Osaka, 577-8502, Japan
| | - Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Kosuke Kitahata
- Division of Chemotherapy, Kindai University Faculty of Pharmacy, Higashi-Osaka, Osaka, 577-8502, Japan
| | - Takako Ujihara
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan; Science Research Center, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Ayuko Taniguchi
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Osamu Yoshie
- The Health and Kampo Institute, Sendai, Miyagi, 981-3205, Japan
| | - Takashi Nakayama
- Division of Chemotherapy, Kindai University Faculty of Pharmacy, Higashi-Osaka, Osaka, 577-8502, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan.
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3
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Lymphome associé au pyothorax. Presse Med 2012; 41:1049-51. [DOI: 10.1016/j.lpm.2011.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/27/2011] [Accepted: 11/30/2011] [Indexed: 11/23/2022] Open
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Abstract
We report 2 cases of pyothorax-associated lymphoma that underwent F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) examinations during pre- and post-treatment states. The FDG PET/CT examinations were able to define the massive lesions as areas of intensive FDG uptake. After radiotherapy, follow-up PET/CT examinations showed the disappearance of the abnormal FDG uptake, although the residual masses remained in the original regions. Finally, we concluded that these lesions had entered remission based on the PET/CT findings. These cases indicate that PET/CT is a useful modality for detecting pyothorax-associated lymphoma and for evaluating the efficacy of treatments.
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Abe Y, Tamura K, Sakata I, Ishida J, Fukuba I, Matsuoka R, Shimizu S, Murakami H, Machida K. Usefulness of (18)F-FDG positron emission tomography/computed tomography for the diagnosis of pyothorax-associated lymphoma: A report of three cases. Oncol Lett 2010; 1:833-836. [PMID: 22966389 DOI: 10.3892/ol_00000146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/26/2010] [Indexed: 11/05/2022] Open
Abstract
Pyothorax-associated lymphoma (PAL) is a unique and rare non-Hodgkin's lymphoma developing in the pleural cavity following a long-standing history of chronic pyothorax (CP). The development of F-18 2'-deoxy-2fluoro-D-glucose (FDG) positron emission tomography combined with computed tomography (PET/CT) has contributed to the evaluation of lymphoma staging. However, only a few studies describing FDG-PET/CT findings in PAL have been published. This study reported three cases of PAL; all 3 patients had previously undergone artificial collapse therapy for pulmonary tuberculosis. Both the first case (an 84-year-old male) and second case (an 83-year-old male) complained of abdominal pain. An ultrasound scan revealed a mass shadow in the left chest wall without abnormal findings in the abdomen, and the CT and magnetic resonance imaging scans suggested malignant lymphoma of the left chest. FDG-PET/CT imaging showed extremely intense FDG uptake only in the left pleura and chest wall. Diagnosis was CP in the two patients, showing a high maximum standardized uptake value (SUVmax: early, 14.8 and delayed, 19.4 in the first case; early, 20.8 and delayed, 27.3 in the second case, respectively). Histopathological analysis of the specimens obtained by biopsy of the PET/CT-positive pleural mass showed non-Hodgkin's, diffuse large B cell lymphoma in the two cases. The third case was a 79-year-old male with relapse after right pleuropneumonectomy for PAL (diffuse large B cell lymphoma) 4 years earlier. PET/CT showed intense FDG uptake (SUVmax: early, 19.9 and delayed, 35.7) in the right pleura and chest wall. Diagnosis was CP, suggesting the recurrence of PAL. Furthermore, abnormal intense FDG uptake was noted in the hilar, mediastinal and supraclavicular lymph nodes, as well as in the spleen. In conclusion, FDG-PET/CT imaging is useful in the evaluation of the area of invasion in PAL.
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Affiliation(s)
- Yoshiyuki Abe
- Tokorozawa PET Diagnostic Imaging Clinic, Tokorozawa 359-1124
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6
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Ito K, Shida Y, Kubota K, Morooka M, Aruga T, Itami J, Matsuda H. The management of pyothorax-associated lymphoma using 18F-FDG PET/CT. Ann Nucl Med 2010; 24:649-54. [DOI: 10.1007/s12149-010-0408-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 07/02/2010] [Indexed: 01/31/2023]
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Narimatsu H, Ota Y, Kami M, Takeuchi K, Suzuki R, Matsuo K, Matsumura T, Yuji K, Kishi Y, Hamaki T, Sawada U, Miyata S, Sasaki T, Tobinai K, Kawabata M, Atsuta Y, Tanaka Y, Ueda R, Nakamura S. Clinicopathological features of pyothorax-associated lymphoma; a retrospective survey involving 98 patients. Ann Oncol 2007; 18:122-128. [PMID: 17043091 DOI: 10.1093/annonc/mdl349] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To investigate clinicopathological features of pyothorax-associated lymphoma (PAL), we examined medical records of 98 patients (88 males and 10 females) with PAL at a median age of 70 years (range 51-86). Seventy-nine patients had a history of artificial pneumothorax. Median interval between diagnosis and artificial pneumothorax was 43 years (range 19-64). At diagnosis, performance status (PS) was 0-1 (n=56) and 2-4 (n=42). Clinical stages were I (n=42), II (n=26), III (n=8) and IV (n=22). Pathological diagnosis comprised diffuse large-B-cell (n=78) and peripheral T-cell lymphoma (n=1). Seventeen were treated supportively. The other 81 received aggressive treatments; chemotherapy (n=52), radiotherapy (n=7), surgery (n=4) and combination (n=18). Five-year overall survival (OS) was 0.35 (95% confidence interval, 24% to 45%). Causes of deaths were PAL (n=39), respiratory failure (n=13) and others (n=12). Multivariate analysis identified prognostic factors for OS; lactate dehydrogenase levels [hazard ratio (HR)=2.36; P=0.013], sex (female versus male) (HR=0.15; P=0.01), PS (2-4 versus 0-1) (HR=2.20; P=0.02), clinical stages (III/IV versus I/II) (HR=1.95; P=0.037) and chemotherapy (HR=0.31; P=0.01). Most patients with PAL are elderly and have comorbidities, while some of them achieve durable remission with appropriate treatments. These findings prompt us to establish an optimal treatment strategy on the basis of risk stratification of individual patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Empyema, Pleural/epidemiology
- Empyema, Pleural/pathology
- Female
- Humans
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/therapy
- Male
- Middle Aged
- Pneumothorax, Artificial
- Prognosis
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- H Narimatsu
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya
| | - Y Ota
- Department of Pathology, Toranomon Hospital, Tokyo
| | - M Kami
- Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo.
| | - K Takeuchi
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo
| | - R Suzuki
- Division of Molecular Medicine, Aichi Cancer Center, Nagoya
| | - K Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya
| | - T Matsumura
- Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo
| | - K Yuji
- Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo
| | - Y Kishi
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical School, Tochigi
| | - T Hamaki
- Department of Transfusion Medicine, Metropolitan Fuchu Hospital, Tokyo
| | - U Sawada
- First Department of Internal Medicine, Nihon University School of Medicine, Tokyo
| | - S Miyata
- Department of Radiology, Toyama Prefectural Central Hospital, Toyama
| | - T Sasaki
- Department of Chemotherapy, Tokyo Metropolitan Komagome Hospital, Tokyo
| | - K Tobinai
- Hematology Division, National Cancer Center Hospital, Tokyo
| | - M Kawabata
- Division of Respiratory Diseases, Toranomon Hospital, Tokyo
| | - Y Atsuta
- Division of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya
| | - Y Tanaka
- Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Tokyo
| | - R Ueda
- Department of Internal Medicine and Molecular Science, Nagoya City University School of Medicine, Nagoya
| | - S Nakamura
- Department of Clinical Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Riehl G, Aubert A, Sandu C, Brichon PY. Malignant non-Hodgkin's lymphoma developing late after pneumonectomy. Eur J Cardiothorac Surg 2006; 30:948-9. [PMID: 17046274 DOI: 10.1016/j.ejcts.2006.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 08/25/2006] [Accepted: 09/01/2006] [Indexed: 11/16/2022] Open
Abstract
A 64-year-old man underwent a left pneumonectomy for a benign bronchial stenosis in 1968. In 1997, a left parietal thoracic tumour: T-type malignant non-Hodgkin's lymphoma (MNHL) was detected. It was treated by chemotherapy and radiation therapy. After 6 years follow-up, the patient is alive and in remission. We have found only one case of such a lymphoma in the literature. It could be classified as pyothorax-associated lymphoma from which there are several published cases especially in Japanese literature.
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Affiliation(s)
- Gregory Riehl
- Department of Thoracic and Vascular Surgery, A. Michallon Teaching Hospital, BP 217, 38043 Grenoble cedex 9, France.
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Asakura H, Togami T, Mitani M, Takashima H, Yokoe K, Yamamoto Y, Nishiyama Y, Monden T, Toyama Y, Ohkawa M. Usefulness of FDG-PET imaging for the radiotherapy treatment planning of pyothorax-associated lymphoma. Ann Nucl Med 2005; 19:725-8. [PMID: 16445000 DOI: 10.1007/bf02985123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pyothorax-associated lymphoma (PAL) is a non-Hodgkin's lymphoma developing in the pleural cavity after a long-standing history of chronic pyothorax (CP). F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is a useful modality for determination of disease extent of various malignant tumors, including malignant lymphoma, but there have been no reports describing the usefulness of FDG-PET imaging in PAL. Here we report a case of PAL that relapsed after chemotherapy and was successfully treated by radiotherapy. FDG-PET imaging revealed that the tumor was localized to a soft-tissue attenuation mass behind the CP cavity in the right thorax, but did not infiltrate the CP cavity. A total dose of 40 Gy was administered to the area that included the PET-positive lesion, instead of including the entire CP cavity in the radiation field. Although computed tomography (CT) showed a residual mass, no FDG uptake was indicated by FDG-PET imaging performed just after the end of radiotherapy, and additional irradiation was not performed. No sign of relapse was found by FDG-PET imaging 3 months later. FDG-PET imaging was useful for both the planning of radiotherapy and assessing the treatment response of PAL.
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Affiliation(s)
- Hirofumi Asakura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
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11
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Aozasa K, Takakuwa T, Nakatsuka SI. Pyothorax-associated lymphoma: a lymphoma developing in chronic inflammation. Adv Anat Pathol 2005; 12:324-31. [PMID: 16330929 DOI: 10.1097/01.pap.0000194627.50878.02] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pyothorax-associated lymphoma (PAL) is a non-Hodgkin lymphoma of exclusively B-cell phenotype developing in the pleural cavity of patients after more than 20-year history of pyothorax resulting from an artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. The most common symptoms on admission are chest pain and fever. Serum neuron-specific enolase level suggesting a diagnosis of small cell lung cancer is occasionally elevated. Histologically PAL usually shows a diffuse proliferation of large cells of B-cell type (diffuse large B-cell lymphoma [DLBL]). In PAL cells, representative B-cell markers other than CD20 are frequently negative with aberrant expression of T-cell markers such as CD2. A gene expression profile of PAL is distinct from nodal DLBL in its higher expression level of interferon-inducible genes. PAL is strongly associated with Epstein-Barr virus (EBV) infection with expression of EBV latent genes such as EBNA-2, LMP-1, together with EBNA-1. Taken together, PAL is a distinct entity both in its clinicopathologic presentation as well as its gene expression profile. Use of an artificial pneumothorax, EBV infection, and cytokines and reactive oxygen species produced in longstanding pyothorax might be important factors for PAL development.
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Affiliation(s)
- Katsuyuki Aozasa
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan.
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12
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Martin Y, Artaz MA, Bornand-Rousselot A. Pyothorax-Associated Lymphoma in an Elderly Woman with a History of Lung Tuberculosis. J Am Geriatr Soc 2004; 52:1226-7. [PMID: 15209679 DOI: 10.1111/j.1532-5415.2004.52327_12.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Androulaki A, Drakos E, Hatzianastassiou D, Vgenopoulou S, Gazouli M, Korkolopoulou P, Patsouris E, Dosios T. Pyothorax-associated lymphoma (PAL): a western case with marked angiocentricity and review of the literature. Histopathology 2004; 44:69-76. [PMID: 14717672 DOI: 10.1111/j.1365-2559.2004.01737.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To report a case of pyothorax-associated lymphoma in a non-immunocompromised 78-year-old man with a 45-year history of tuberculous pleuritis and left pleural effusion. Pyothorax-associated lymphoma is a high-grade non-Hodgkin's lymphoma occurring in 2% of patients with long-standing tuberculous pleuritis and pyothorax. Pyothorax-associated lymphoma is frequently Epstein-Barr virus (EBV)-associated, mainly reported in Japan but exceedingly rare in western countries. METHODS AND RESULTS Histology revealed a high-grade, diffuse large B-cell lymphoma with immunoblastic and plasmacytoid features and marked angiocentricity with focal destruction of the vessel walls. Immunohistochemistry revealed a post germinal B-cell phenotype. RNA in-situ hybridization and molecular analysis showed a latent EBV infection and absence of human herpes virus-8 (HHV-8). CONCLUSIONS Pyothorax-associated lymphoma represents a rare but distinctive type of diffuse large B-cell lymphoma, with characteristic clinico-epidemiological, immunohistological, and biological features.
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MESH Headings
- Aged
- Biomarkers, Tumor/metabolism
- Empyema, Pleural/complications
- Empyema, Pleural/metabolism
- Empyema, Pleural/pathology
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/pathology
- Fatal Outcome
- Greece
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- In Situ Hybridization
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Male
- Pleural Neoplasms/complications
- Pleural Neoplasms/metabolism
- Pleural Neoplasms/pathology
- RNA, Viral/analysis
- Vascular Neoplasms/pathology
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Affiliation(s)
- A Androulaki
- Department of Pathology, Laiko General Hospital, Medical School, University of Athens, Athens, Greece
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Shide K, Henzan H, Nagafuji K, Aoki K, Miyamoto T, Shimoda K, Kazuyama Y, Ohshima K, Gondo H, Harada M. Dynamics of Epstein-Barr virus load in pyothorax-associated lymphoma. J Med Virol 2003; 70:137-40. [PMID: 12629655 DOI: 10.1002/jmv.10374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We treated a 73-year-old man who developed a pyothorax-associated pleural lymphoma after a 52-year history of tuberculous pleuritis. The lymphoma was classified histologically as a diffuse large, B-cell type. Epstein-Barr virus (EBV) was identified in the tumor by immunocytochemical and molecular methods. Chemotherapy both without and with the addition of rituximab was only minimally effective, but adding radiotherapy to chemotherapy reduced the tumor size, resulting in a partial remission. The EBV load measured by a quantitative real-time polymerase chain reaction correlated well with the tumor size and the serum lactate dehydrogenase concentration. Monitoring the EBV load may be useful in the management of pyothorax-associated lymphoma.
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Affiliation(s)
- Kotaro Shide
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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