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Bae M, Song JS, Kim JY, Bae S, Jung J, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Kim SH. The relationship between organising pneumonia and invasive mould disease in patients with haematologic malignancy. Mycoses 2023; 66:289-298. [PMID: 36482152 DOI: 10.1111/myc.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Organising pneumonia (OP) is reported in patients with haematologic malignancy suspected of having invasive mould disease, yet little is known about this relationship. OBJECTIVE To investigate molecular evidence of invasive mould pneumonia in paraffin-embedded lung tissues from histologically diagnosed OP patients with suspected invasive mould pneumonia. PATIENTS/METHODS Patients with haematologic malignancy suspected to have invasive pulmonary mould disease who underwent lung biopsy at a tertiary hospital, Seoul, South Korea, between 2008 and 2020, were retrospectively reviewed. To find molecular evidence of fungal infection, PCR assay was used to detect Aspergillus- and Mucorales-specific DNA within OP lung tissue sections. RESULTS Forty-seven patients with suspected invasive mould pneumonia underwent lung biopsy and 15 (32%) were histologically diagnosed as OP without any evidence of fungal hyphae. Of these 15 patients, 3 (20%) received allogenic haematopoietic stem cell transplantation prior to developing OP. Before biopsy, 2 and 13 patients had probably and possible invasive mould disease, respectively. The median antifungal treatment length was 81 [8-114] days, and the median steroid treatment dosage was 0.35 mg/kg/day for 36 days (methylprednisolone equivalent doses), respectively. After biopsy, three patients with possible invasive mould infection revealed probable invasive pulmonary aspergillosis. From the 15 paraffin-embedded lung tissues, 6 (40%) exhibited positive PCR assay results for detecting Aspergillus- and Mucorales-specific DNA. CONCLUSIONS More than one third of OP cases in patients with suspected invasive mould pneumonia exhibited molecular evidence of invasive mould infection by fungus-specific PCR in lung tissues, likely associated with concurrent or prior fungal infection.
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Affiliation(s)
- Moonsuk Bae
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.,Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Yeun Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seongman Bae
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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2
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Zeng H, Ma Y, He X, Cai S, Chen P, Chen Y, Luo H. Characteristics and Follow-Up of Organizing Pneumonia Associated with Haematological Malignancies. Int J Gen Med 2022; 15:301-310. [PMID: 35027840 PMCID: PMC8752074 DOI: 10.2147/ijgm.s337321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Organizing pneumonia (OP) is a secondary process in many diseases. Due to its low incidence and indistinct symptoms, there is limited information on OP associated with haematological malignancies. Therefore, the aim of this study was to discuss the characteristics and prognosis of OP associated with haematological malignancies. Methods We observed and analysed pathologically confirmed OP cases associated with haematological malignancies in a hospital record database and excluded cases of OP with known causes, including chemotherapy, radiotherapy, targeted therapy, transplantation and infection. Results There were five patients with OP underlying only haematological malignancies, including one case each of the following: myelodysplastic syndrome, acute myelogenous leukaemia, multiple myeloma, aplastic anaemia, and T cell lymphoma. Radiological findings did not show a distinct pattern, and two cases mimicked pulmonary aspergillosis with ground-glass opacity (GGO). The diagnosis of OP was confirmed by minimal invasive biopsy. Although all patients developed severe cases, steroids yielded favourable outcomes. Conclusion This study demonstrates that haematological malignancies may be a cause of OP and that minimal invasive biopsy may be an effective and safe method to confirm the diagnosis. Although OP associated with haematological malignancies may more frequently develop into severe cases, the OP lesions were steroid-responsive during follow-up.
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Affiliation(s)
- Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Xue He
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
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3
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Ziatabar S, Sherman E, Ye QQ, Han L, Epelbaum O. Lung metastases from sinonasal leiomyosarcoma masked by organizing pneumonia. Thorac Cancer 2021; 12:2822-2824. [PMID: 34453493 PMCID: PMC8520816 DOI: 10.1111/1759-7714.14053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sally Ziatabar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Ester Sherman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Qi Qi Ye
- Department of Pathology, Westchester Medical Center, Valhalla, New York, USA
| | - Liying Han
- Department of Pathology, Westchester Medical Center, Valhalla, New York, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, New York, USA
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4
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Chan C, Fagarasanu AD, Reid A, Sadowski DC, Gillson AE. Organizing pneumonia associated with T-cell lymphoma. Respirol Case Rep 2020; 8:e00677. [PMID: 33133608 PMCID: PMC7586110 DOI: 10.1002/rcr2.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/10/2020] [Accepted: 10/01/2020] [Indexed: 11/07/2022] Open
Abstract
A 61-year-old male with a history of coeliac disease was diagnosed with organizing pneumonia (OP) on transbronchial and transthoracic lung biopsies. He then developed refractory coeliac disease type II and haemophagocytic lymphohistiocytosis. Nine months after his initial diagnosis of OP and after multiple biopsies of the lung, duodenum, and bone marrow, he was diagnosed with enteropathy-associated T-cell lymphoma (EATL). Although OP in patients with lymphoma is most commonly attributed to chemotherapeutic agents or bone marrow transplant, it may be seen in the absence of prior anticancer treatment. The mechanism linking OP and lymphoma is unclear but OP could represent a syndrome of T-cell dysfunction or develop as a direct reaction to malignant infiltration of the lung. In patients with atypical presentations, exclusion of an alternate diagnosis must be pursued using surgical lung biopsy, wherever possible. This is the first reported case of OP associated with EATL.
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Affiliation(s)
- Chrystal Chan
- Department of MedicineUniversity of AlbertaEdmontonABCanada
| | | | - Andre Reid
- Department of Laboratory Medicine & PathologyUniversity of AlbertaEdmontonABCanada
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5
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Kozlova N, Rozenshtein A, Mikkilineni S, Linnik Y, Epelbaum O. What lies beneath: poking a hole in the diagnosis. Thorax 2020; 75:1017-1019. [PMID: 32820082 DOI: 10.1136/thoraxjnl-2020-214745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/28/2020] [Accepted: 07/11/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Natalya Kozlova
- Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Anna Rozenshtein
- Department of Radiology, Section of Cardiac and Thoracic Imaging, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Soumya Mikkilineni
- Department of Pathology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Yevgeniy Linnik
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Oleg Epelbaum
- Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
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6
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Tiralongo F, Palermo M, Distefano G, Vancheri A, Sambataro G, Torrisi SE, Galioto F, Ferlito A, Fazio G, Foti PV, Mauro LA, Vancheri C, Palmucci S, Basile A. Cryptogenic Organizing Pneumonia: Evolution of Morphological Patterns Assessed by HRCT. Diagnostics (Basel) 2020; 10:diagnostics10050262. [PMID: 32365469 PMCID: PMC7277545 DOI: 10.3390/diagnostics10050262] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023] Open
Abstract
To evaluate the radiological findings in patients with cryptogenic organizing pneumonia (COP) before steroid treatment and their behavior after therapy, we retrospectively evaluated a total of 22 patients with a diagnosis of COP made by bronchoalveolar lavage (BAL), biopsy or clinical/radiological features, and the patients were followed between 2014 and 2018 at the hospital; the demographic data, symptoms, radiologic findings, diagnostic methods and treatment plans of patients were collected from patients’ hospital records. At least two CT scans of 22 patients (16 female and six men) were evaluated, the first one before starting steroid therapy and the others after therapy. At baseline CT scans, the most common radiological finding was the presence of consolidations (18/22 patients, 81.8%); ground-glass opacities were also very common (15/25, 68.1%). The other findings were as follows: nodules and masses (5/22, 22.7%), atoll sign (4/22, 18.1%), perilobular pattern (3/22, 13.6%) and parenchymal bands (3/22, 13.6%). Two patients had a significant relapse after reducing/interrupting therapy, while three had a complete resolution and are not currently under therapy (maintenance of clinical remission with no oral corticosteroid (OCS)). In High-resolution computed tomography (HRCT) scans after therapy, consolidations were still observable in seven patients (five in new areas of the lung-migratory infiltrates), while most of them disappeared, leaving a residual area of ground glass opacity in two patients. One patient had a residual of the perilobular pattern, with the disappearing of the other findings (consolidations and ground-glass opacities). Two patients developed a fibrosing pattern despite the therapy (9.5%). Cryptogenic organizing pneumonia tends to respond to oral corticosteroid treatment, but some patients may have a null or partial response. We highlight the behavior of this disease after proper therapy.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Monica Palermo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Giulio Distefano
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Ada Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Artroreuma S.R.L., Outpatient of Rheumatology associated with the National Health System, Corso S. Vito 53, 95030 Mascalucia (Catania), Italy
| | - Sebastiano Emanuele Torrisi
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Federica Galioto
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Agata Ferlito
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Giulia Fazio
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Letizia Antonella Mauro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Dept. of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy
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7
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Mao R, Zhang L, Hou J, Zou Y, Zhu L, Chen Z. Organizing pneumonia secondary to lung cancer of unknown primary site. Respir Med Case Rep 2019; 28:100892. [PMID: 31312597 PMCID: PMC6610690 DOI: 10.1016/j.rmcr.2019.100892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background Secondary organizing pneumonia (OP) is associated with other pathological conditions, such as infections, drugs, cancers and radiotherapy. Lung cancer-associated secondary OP has rarely been reported. Case review In this study, we reported on a case of secondary OP caused by lung cancer. The patient was initially diagnosed with community-acquired pneumonia and then cryptogenic organizing pneumonia by CT scan-guided and transbronchial lung biopsy. Poor response to anti-infection or corticosteroid therapy prompted us to search for underlying disease. A TBNA biopsy of the 4R mediastinal lymph node revealed the diagnosis of lung cancer. Conclusion OP secondary to lung cancer of unknown primary site are rare. When OP patients have lymphadenopathy or poor response to glucocorticoid, a more differential diagnosis should be considered, especially for avoiding the misdiagnosis of a malignancy.
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Affiliation(s)
- Ruolin Mao
- Respiratory Division of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lianpeng Zhang
- Respiratory Division, People's Hospital of Qingzhou City, Qingzhou, Shandong, China
| | - Jun Hou
- Pathology Division of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yining Zou
- Pathology Division of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Zhu
- Respiratory Division of Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding author. Shanghai Institute of Respiratory Diseases, Respiratory Division of Zhongshan Hospital, Fudan University, No.180 Fenglin Road, 200032, Shanghai, China.
| | - Zhihong Chen
- Respiratory Division of Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding author. Shanghai Institute of Respiratory Diseases, Respiratory Division of Zhongshan Hospital, Fudan University, No.180 Fenglin Road, 200032, Shanghai, China.
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8
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Hosoda C, Saito K, Fujimoto S, Yamanaka Y, Watanabe N, Miyagawa H, Kurita Y, Seki Y, Kinoshita A, Endo Y, Kuwano K. Pulmonary alveolar proteinosis developing during steroid treatment in a patient with organizing pneumonia in association with atypical chronic myeloid leukemia. Clin Case Rep 2019; 7:477-481. [PMID: 30899476 PMCID: PMC6406221 DOI: 10.1002/ccr3.2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/20/2018] [Accepted: 01/04/2019] [Indexed: 11/09/2022] Open
Abstract
Organizing pneumonia (OP) and pulmonary alveolar proteinosis (PAP) are rare complications in patients with hematologic disorders. We herein report a case of PAP that developed during steroid treatment for OP in a patient with atypical chronic myeloid leukemia. Physicians should pay close attention to these complications in patients with hematologic malignancies.
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Affiliation(s)
- Chiaki Hosoda
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Keisuke Saito
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Shota Fujimoto
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Yumie Yamanaka
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Naoaki Watanabe
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Hanae Miyagawa
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Yusuke Kurita
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Yoshitaka Seki
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Akira Kinoshita
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University Daisan HospitalTokyoJapan
| | - Yasuhiko Endo
- Department of PathologyThe Jikei University School of MedicineTokyoJapan
| | - Kazuyoshi Kuwano
- Department of Internal Medicine, Division of Respiratory MedicineThe Jikei University School of MedicineTokyoJapan
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9
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Respiratory Tract Diseases That May Be Mistaken for Infection. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7119916 DOI: 10.1007/978-1-4939-9034-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Lal A, Davis MJ, Akhtar J, Chen Y, Davis S. Serious Cover-Up: Hodgkin's Lymphoma Masked by Organizing Pneumonia. Am J Med 2018; 131:1174-1177. [PMID: 29660353 DOI: 10.1016/j.amjmed.2018.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Amos Lal
- Department of Medicine, Saint Vincent Hospital, Worcester, Mass.
| | | | - Jamal Akhtar
- Department of Medicine, Saint Vincent Hospital, Worcester, Mass
| | - Yayan Chen
- Department of Pathology, Saint Vincent Hospital, Worcester, Mass
| | - Steven Davis
- Division of Pulmonology and Sleep Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, Mass
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11
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Namitha R, Nimisha KP, Yusuf N, Rauf CP. Air leak: An unusual manifestation of organizing pneumonia secondary to bleomycin. Lung India 2017; 34:173-175. [PMID: 28360468 PMCID: PMC5351362 DOI: 10.4103/0970-2113.201306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Organizing pneumonia (OP) is a less common interstitial lung disease with varying clinical picture. The development of pulmonary air leak in a case of OP is an extremely rare complication. Here, we report the case of a 46-year-old female with carcinoma ovary, postchemotherapy who developed respiratory distress with pneumomediastinum, and subcutaneous emphysema. Lung biopsy showed evidence of OP. This turned out to be a rare case of OP, secondary to bleomycin chemotherapy, presenting with pulmonary air leak.
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Affiliation(s)
- R Namitha
- Department of Pulmonology, Chest Hospital, Kozhikode, Kerala, India
| | - K P Nimisha
- Department of Pulmonology, Chest Hospital, Kozhikode, Kerala, India
| | - Nasser Yusuf
- Department of Pulmonology and Thoracic Surgery, Chest Hospital, Kozhikode, Kerala, India
| | - C P Rauf
- Department of Pulmonology and Thoracic Surgery, Chest Hospital, Kozhikode, Kerala, India
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12
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Gupta A, Teo L, Masel P, Godbolt D, Beadle G. Transtuzumab induced organizing pneumonia: a case report. SPRINGERPLUS 2016; 5:1964. [PMID: 27933242 PMCID: PMC5108743 DOI: 10.1186/s40064-016-3647-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/03/2016] [Indexed: 01/05/2023]
Abstract
Background Patients with metastatic breast cancer often have pulmonary symptoms with varying aetiologies. Transtuzumab is an extremely important drug used in the treatment of Her 2 neu over-expressing breast cancers. In this report we describe a case of organizing pneumonia associated with use of transtuzumab in metastatic breast cancer. Only three such cases have previously been reported. Case description A 43 year old lady with Her 2 neu 3+, estrogen and progesterone receptor positive, metastatic breast cancer was started on weekly transtuzumab and albumen bound paclitaxel. She was admitted with an episode of bilateral pneumonitis after her fourth dose of therapy. It was managed conservatively with antibiotics. Subsequently, single agent transtuzumab was administered resulting in an anaphylactoid reaction followed by worsening dyspnoea requiring hospitalization and oxygen support for 3 days. Discussion and evaluation The pneumonitis warranted further investigations including bronchoscopy which were performed. Bronchoscopic biopsy was consistent with a diagnosis of organizing pneumonia. Transtuzumab was stopped and she was started on steroids (dexamethasone). She improved remarkably and was discharged home on hormonal therapy, lapatinib and tapering doses of steroids. Conclusion Organizing pneumonia closely mimics infection or progressive disease and can be difficult to diagnose in the setting of malignancy. Correct diagnosis is of paramount importance since delay in treatment can result in significantly adverse patient outcomes.
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Affiliation(s)
- Ajay Gupta
- Asian Cancer Center, Faridabad, India ; Medical Oncology, Hervey Bay Hospital, Hervey Bay, QLD Australia
| | - Louise Teo
- Medical Oncology, Hervey Bay Hospital, Hervey Bay, QLD Australia
| | - Philip Masel
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD Australia
| | - David Godbolt
- Department of Pathology, The Prince Charles Hospital, Chermside, QLD Australia
| | - Geoffrey Beadle
- Department of Medical Oncology, Wesley Hospital, Auchenflower, QLD Australia
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13
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Souto Filho JTD, Pereira SM, Duncan LR, Alves LL, Barreto LDA, Meireles PA. Resolution of organizing pneumonia following immunosuppressive therapy for large granular lymphocytic leukemia. Ann Hematol 2016; 95:1357-9. [DOI: 10.1007/s00277-016-2687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022]
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14
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Petitpierre N, Beigelman C, Letovanec I, Lazor R. [Cryptogenic organizing pneumonia]. Rev Mal Respir 2016; 33:703-717. [PMID: 26857200 DOI: 10.1016/j.rmr.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 08/21/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Organizing pneumonia is a particular type of inflammatory reaction of the lung which gives rise to a clinico-pathological syndrome. It is called "secondary" when a cause such as an infection, a drug toxicity, or a connective tissue disease can be identified, or "cryptogenic" when no cause is identified. The clinical picture is usually characterized by the subacute onset of fever, fatigue, cough and dyspnea, with multiple subpleural areas of consolidation on thoracic imaging. STATE OF THE ART Organizing pneumonia is characterised by the presence of buds of endoalveolar connective tissue. These result from an injury to the alveolar epithelium, followed by the deposition of fibrin in the alveolar spaces, and the migration of fibroblasts which produce a myxoid endoalveolar matrix. A remarkable feature of organizing pneumonia is the complete disappearance of these endoalveolar buds with corticosteroid treatment, in sharp contrast with what is seen in pulmonary fibrosis. The clinical response to corticosteroids is usually prompt and excellent. Relapses are frequent but usually benign. PERSPECTIVES AND CONCLUSION As the clinical, imaging and pathological characteristics of organizing pneumonia are now well established, many questions remain unanswered, such as the mechanisms involved in the complete reversibility of the pulmonary lesions, and the role of steroid-sparing treatments such as immunomodulatory macrolides.
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Affiliation(s)
- N Petitpierre
- Unité des pneumopathies interstitielles et maladies pulmonaires rares, service de pneumologie, centre hospitalier universitaire vaudois (CHUV), 46, rue du Bugnon, 1011 Lausanne, Suisse
| | - C Beigelman
- Service de radiodiagnostic et de radiologie interventionnelle, centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse
| | - I Letovanec
- Institut universitaire de pathologie, centre hospitalier universitaire vaudois (CHUV), Lausanne, Suisse
| | - R Lazor
- Unité des pneumopathies interstitielles et maladies pulmonaires rares, service de pneumologie, centre hospitalier universitaire vaudois (CHUV), 46, rue du Bugnon, 1011 Lausanne, Suisse; Centre national de référence des maladies pulmonaires rares, hôpital Louis-Pradel, hospices civils de Lyon, 69000 Lyon, France.
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15
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Feinstein MB, DeSouza SA, Moreira AL, Stover DE, Heelan RT, Iyriboz TA, Taur Y, Travis WD. A comparison of the pathological, clinical and radiographical, features of cryptogenic organising pneumonia, acute fibrinous and organising pneumonia and granulomatous organising pneumonia. J Clin Pathol 2015; 68:441-7. [PMID: 25742910 DOI: 10.1136/jclinpath-2014-202626] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 02/12/2015] [Indexed: 01/24/2023]
Abstract
AIMS Cryptogenic organising pneumonia (COP) and acute fibrinous and organising pneumonia (AFOP) are recognised patterns of organising pneumonia (OP), a condition that resembles pneumonia but is not caused by infection. We have recognised granulomatous organising pneumonia (GOP) to be a similar histopathological entity where non-necrotising granulomata are intimately associated with the organising connective tissue. To what degree COP, AFOP and GOP represent distinct clinical and pathological disorders is unknown. This cross-sectional study sought to compare the pathological, clinical, and radiographical features of these OP patterns. METHODS Surgical lung biopsy specimens were reviewed for consecutive patients referred with OP to a metropolitan cancer centre. Clinical information and CT images were acquired from the hospital electronic medical record to determine the clinical and CT characteristics of each OP pattern. RESULTS Sixty-one patients (35 men, 26 women), mean age 61.5 years (range 8-85 years), were available for analysis. Of these, 43 patients (70%) had at least one prior cancer; 27 (44%) had received chemotherapy and 18 (30%) had received radiation. Approximately, half (32 patients) had respiratory symptoms, most commonly cough, dyspnoea and/or wheezing. While symptoms and mortality rates were not different among OP groups, AFOP patients more commonly had fever (p=0.04). GOP patients less commonly had received chemotherapy (p=0.03) and were more likely to present as masses/nodules (p=0.04). CONCLUSIONS AFOP and GOP, a newly described OP form, possess clinical and pathological findings that set it apart from a COP, suggesting an emerging spectrum of OP.
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Affiliation(s)
- Marc B Feinstein
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Shilpa A DeSouza
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Andre L Moreira
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Diane E Stover
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Robert T Heelan
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Tunç A Iyriboz
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ying Taur
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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16
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Abstract
Organizing pneumonia is a particular type of inflammatory and reparative reaction of the lung parenchyma characterized by fibroblast proliferation in the distal airspaces with overall preservation of the lung architecture. When microscopic, it is an asymptomatic and nonspecific reaction of little clinical significance accompanying many pathological processes. When macroscopic and affecting large portions of the lung parenchyma, it manifests by restrictive ventilatory defect and gas exchange impairment leading to dyspnea, cough, hypoxemia, alveolar opacities at chest imaging, and symptoms of systemic inflammation such as fever, malaise, and weight loss. This picture constitutes the clinico-pathological syndrome of organizing pneumonia, which has been recognized and characterized as a distinct entity in the past 30 years. Although the classical features of organizing pneumonia are increasingly familiar to chest physicians, and the efficacy of corticosteroid treatment makes it appear at first sight as an easy problem to resolve, atypical clinical presentations, similarities with other diseases, severe forms, histological variants, side effects of therapy, and relapses can make the management more difficult than initially expected. This chapter will address the classical and less common features of organizing pneumonia, and will provide practical clues to the diagnosis and management of this disorder.
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Affiliation(s)
- Vincent Cottin
- grid.413858.3Rare Pulmonary Diseases, Hôpital Louis Pradel, Lyon, France
| | | | - Luca Richeldi
- grid.5491.90000000419369297Respiratory Medicine, University of Southampton, Southampton, United Kingdom
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17
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La Verde N, Piva S, Colombo F, Borgonovo K, Gramegna G, Girelli S, Dimaiuta M, Galfrascoli E, Battaglia E, Farina G. Lung infiltrates in cancer patients: differentiating metastases from bronchiolitis obliterans organizing pneumonia. Immunopharmacol Immunotoxicol 2012; 35:195-7. [PMID: 23098222 DOI: 10.3109/08923973.2012.733706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare condition that affects oncological patients, often during or after chemotherapy, and can easily be mistaken for lung metastases. BOOP should be taken into consideration in cases when patchy nodular infiltrates with uncertain behavior appear in the lung; these infiltrates are often unresponsive to treatment with antibiotics. We report a case in which a patient treated for transitional cell bladder carcinoma with surgery and adjuvant chemotherapy developed multiple bilateral pulmonary nodules one month after the end of treatment.
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Affiliation(s)
- Nicla La Verde
- Department of Oncology, A.O. Fatebenefratelli e Oftalmico, Milan, Italy.
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18
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Murai T, Shibamoto Y, Nishiyama T, Baba F, Miyakawa A, Ayakawa S, Ogino H, Otsuka S, Iwata H. Organizing pneumonia after stereotactic ablative radiotherapy of the lung. Radiat Oncol 2012; 7:123. [PMID: 22853821 PMCID: PMC3480881 DOI: 10.1186/1748-717x-7-123] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/17/2012] [Indexed: 01/22/2023] Open
Abstract
Background Organizing pneumonia (OP), so called bronchiolitis obliterans organizing pneumonia after postoperative irradiation for breast cancer has been often reported. There is little information about OP after other radiation modalities. This cohort study investigated the clinical features and risk factors of OP after stereotactic ablative radiotherapy of the lung (SABR). Methods Patients undergoing SABR between 2004 and 2010 in two institutions were investigated. Blood test and chest computed tomography were performed at intervals of 1 to 3 months after SABR. The criteria for diagnosing OP were: 1) mixture of patchy and ground-glass opacity, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lesion in the lung volume receiving < 0.5 Gy, and 4) no evidence of a specific cause. Results Among 189 patients (164 with stage I lung cancer and 25 with single lung metastasis) analyzed, nine developed OP. The incidence at 2 years was 5.2% (95% confidence interval; 2.6-9.3%). Dyspnea were observed in all patients. Four had fever. These symptoms and pulmonary infiltration rapidly improved after corticosteroid therapy. Eight patients had presented with symptomatic radiation pneumonitis (RP) around the tumor 2 to 7 months before OP. The prior RP history was strongly associated with OP (hazard ratio 61.7; p = 0.0028) in multivariate analysis. Conclusions This is the first report on OP after SABR. The incidence appeared to be relatively high. The symptoms were sometimes severe, but corticosteroid therapy was effective. When patients after SABR present with unusual pneumonia, OP should be considered as a differential diagnosis, especially in patients with prior symptomatic RP.
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Affiliation(s)
- Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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19
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Narasimhaiah DH, Chakravorty I, Swamy R, Prakash D. Organising pneumonia presenting as acute life threatening pulmonary haemorrhage. BMJ Case Rep 2011; 2011:bcr.03.2009.1689. [PMID: 22674096 DOI: 10.1136/bcr.03.2009.1689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Organising pneumonia, previously called bronchiolitis obliterans organising pneumonia is a clinicopathological entity of unknown aetiology, which has been reported with increasing frequency. Various modes of presentation have been described such as cough, fever, weight loss and alveolar opacities on chest radiograph. Haemoptysis as primary presenting symptom has only rarely been reported. The authors report a case in which massive life-threatening haemoptysis was the major presenting symptom. No aetiology was identified for the haemoptysis and the diagnosis was confirmed on postmortem histology. This case highlights the importance of considering organising pneumonia in the differential diagnosis of acute severe haemoptysis.
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20
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Epler GR. Bronchiolitis obliterans organizing pneumonia, 25 years: a variety of causes, but what are the treatment options? Expert Rev Respir Med 2011; 5:353-61. [PMID: 21702658 DOI: 10.1586/ers.11.19] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Bronchiolitis obliterans organizing pneumonia is an inflammatory lung disease involving the distal bronchioles, respiratory bronchioles, bronchiolar ducts and alveoli. Its cause is generally unknown, but there are several known causes and associated systemic diseases. The clinical features include cough, shortness of breath and bilateral crackles. The vital capacity is slightly decreased, and the diffusing capacity is moderately to severely decreased. The high-resolution chest CT scan shows bilateral ground-glass opacities with air bronchograms and triangular, pleura-based opacities. Corticosteroid therapy is the best treatment option. The outcome of patients suffering from bronchiolitis obliterans organizing pneumonia is good, as up to 80% of individuals will be cured.
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Affiliation(s)
- Gary R Epler
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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21
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Kimura Y, Imamura Y, Higaki K, Ohno Y, Hashiguchi N, Seki R, Okamura T, Arakawa F, Kiyasu J, Takeuchi M, Miyoshi H, Yoshida M, Nakamura Y, Niino D, Sugita Y, Ohshima K. Case of polycythemia vera with unusual organizing pneumonia mimicking the clinical features of military tuberculosis and possibly caused by the involvement of neoplastic megakaryocytes. Pathol Int 2011; 61:486-90. [PMID: 21790864 DOI: 10.1111/j.1440-1827.2011.02687.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Polycythemia vera (PV) is a clonal myeloproliferative neoplasm (MPN) of hematopoietic stem cells. Although the management of MPN patients generally focuses on the prevention of thromboembolic events caused by hypercoagulability, it is true that the patients with hematological malignancy often suffer from pulmonary diseases with atypical radiological patterns. We present here a 56-year-old woman with PV harboring a JAK2(V617F) mutation that had a diffuse reticulonodular pattern on chest radiography and was initially suspected of having military tuberculosis. Pathological assessment of a video-assisted thoracoscopic surgery lung biopsy revealed that the lesions were in fact organizing pneumonia (OP). Interestingly, pulmonary extramedullary hematopoiesis with a diffuse plugging of the alveolar blood capillaries by numerous atypical megakaryocytes was also observed around the granulation components. The histological findings of our case of unusual OP suggest that local activated neoplastic megakaryocytes and platelets played an important role in the development of spreading fibrotic lesions. JAK2 mutation or the preleukemic phase of MPN may accelerate the activation of megakaryocytes and result in the proliferative process of fibrosis.
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Affiliation(s)
- Yoshizo Kimura
- Department of Pathology, School of Medicine, Kurume University, Kurume-city, Fukuoka, Japan.
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22
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Azoulay E. What Has Been Learned from Postmortem Studies? PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123032 DOI: 10.1007/978-3-642-15742-4_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infectious and noninfectious pulmonary diseases are commonly found on postmortem autopsy studies in patients with hematological malignancy. Despite the technological advances in diagnostic testing and imaging modalities, obtaining an accurate clinical diagnosis remains difficult and often not possible until autopsy. Major diagnostic discrepancies between clinical premortem diagnoses and postmortem autopsy findings have been reported in these patients. The most common missed diagnoses are due to opportunistic infections and cardiopulmonary complications. These findings underscore the importance of enhanced surveillance, monitoring and treatment of infections and cardiopulmonary disorders in these patients. Autopsies remain important in determining an accurate cause of death and for improved understanding of diagnostic deficiencies, as well as for medical education and quality assurance.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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23
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Plasma cell leukemia presenting as organizing pneumonia refractory to high-dose steroid therapy. South Med J 2010; 103:706-10. [PMID: 20531051 DOI: 10.1097/smj.0b013e3181e206da] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of steroid-refractory organizing pneumonia (OP) as the initial presentation of plasma cell leukemia (PCL) in a patient who had no prior exposure to chemotherapy or radiation is described. Since OP is traditionally a steroid-responsive disease, this case raises the possibility of a previously unknown patient subgroup with variable disease pattern and/or behavior in patients with plasma cell neoplasm.
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24
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Dalal PU. Non-metastatic manifestations of cancer in the chest. IMAGING 2008. [DOI: 10.1259/imaging/83642253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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25
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Chakravorty I, Oldfield WLG, Gómez CMH. Rapidly progressive Bronchiolitis Obliterans Organising Pneumonia presenting with pneumothorax, persistent air leak, acute respiratory distress syndrome and multi-organ dysfunction: a case report. J Med Case Rep 2008; 2:145. [PMID: 18460192 PMCID: PMC2397425 DOI: 10.1186/1752-1947-2-145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 05/06/2008] [Indexed: 11/24/2022] Open
Abstract
Introduction Bronchiolitis Obliterans Organising Pneumonia (BOOP) may often present initially as a recurrent spontaneous pneumothorax and then develop multi-system complications. Case presentation A 17-year-old boy presented with a pneumothorax, which developed into rapidly progressive Bronchiolitis Obliterans Organising Pneumonia (BOOP). He developed multi-organ dysfunction (including adult respiratory distress syndrome, oliguric renal failure, acute coronary syndrome, cardiac failure and a right atrial thrombus) which necessitated prolonged intensive care. Diagnosis was confirmed on open lung biopsy and he responded well to treatment with corticosteroids. Conclusion BOOP is exquisitely sensitive to oral corticosteroids but if the diagnosis is not considered in such patients and appropriate treatment instituted early, BOOP may often lead to prolonged hospital admission with considerable morbidity.
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Affiliation(s)
- Indranil Chakravorty
- Department of Respiratory Medicine, Lister Hospital, Beds & Herts Postgraduate Medical School, Stevenage, UK.
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26
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Lioté H. Organizing pneumonia associated with rituximab: Challenges raised by establishing causality. Joint Bone Spine 2008; 75:260-2. [DOI: 10.1016/j.jbspin.2008.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 02/15/2008] [Indexed: 10/22/2022]
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27
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Fazekas T, Wiesbauer P, Kronberger M, Wank H, Gadner H, Dworzak M. Nodular pulmonary lesions in children after autologous stem cell transplantation: a source of misinterpretation. Br J Haematol 2008; 140:429-32. [DOI: 10.1111/j.1365-2141.2007.06951.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Yee KWL, Zeng Z, Konopleva M, Verstovsek S, Ravandi F, Ferrajoli A, Thomas D, Wierda W, Apostolidou E, Albitar M, O'Brien S, Andreeff M, Giles FJ. Phase I/II study of the mammalian target of rapamycin inhibitor everolimus (RAD001) in patients with relapsed or refractory hematologic malignancies. Clin Cancer Res 2007; 12:5165-73. [PMID: 16951235 DOI: 10.1158/1078-0432.ccr-06-0764] [Citation(s) in RCA: 246] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Everolimus (RAD001, Novartis), an oral derivative of rapamycin, inhibits the mammalian target of rapamycin (mTOR), which regulates many aspects of cell growth and division. A phase I/II study was done to determine safety and efficacy of everolimus in patients with relapsed or refractory hematologic malignancies. EXPERIMENTAL DESIGN Two dose levels (5 and 10 mg orally once daily continuously) were evaluated in the phase I portion of this study to determine the maximum tolerated dose of everolimus to be used in the phase II study. RESULTS Twenty-seven patients (9 acute myelogenous leukemia, 5 myelodysplastic syndrome, 6 B-chronic lymphocytic leukemia, 4 mantle cell lymphoma, 1 myelofibrosis, 1 natural killer cell/T-cell leukemia, and 1 T-cell prolymphocytic leukemia) received everolimus. No dose-limiting toxicities were observed. Grade 3 potentially drug-related toxicities included hyperglycemia (22%), hypophosphatemia (7%), fatigue (7%), anorexia (4%), and diarrhea (4%). One patient developed a cutaneous leukocytoclastic vasculitis requiring a skin graft. One patient with refractory anemia with excess blasts achieved a major platelet response of over 3-month duration. A second patient with refractory anemia with excess blasts showed a minor platelet response of 25-day duration. Phosphorylation of downstream targets of mTOR, eukaryotic initiation factor 4E-binding protein 1, and/or, p70 S6 kinase, was inhibited in six of nine patient samples, including those from the patient with a major platelet response. CONCLUSIONS Everolimus is well tolerated at a daily dose of 10 mg daily and may have activity in patients with myelodysplastic syndrome. Studies of everolimus in combination with therapeutic agents directed against other components of the phosphatidylinositol 3-kinase/Akt/mTOR pathway are warranted.
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MESH Headings
- Adaptor Proteins, Signal Transducing/antagonists & inhibitors
- Administration, Oral
- Adolescent
- Adult
- Aged
- Cell Cycle Proteins
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drug-Related Side Effects and Adverse Reactions
- Everolimus
- Female
- Humans
- Killer Cells, Natural/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Prolymphocytic/drug therapy
- Leukemia, T-Cell/drug therapy
- Lymphoma, Mantle-Cell/drug therapy
- Male
- Maximum Tolerated Dose
- Middle Aged
- Myelodysplastic Syndromes/drug therapy
- Phosphoproteins/antagonists & inhibitors
- Phosphorylation
- Protein Kinases/drug effects
- Protein Kinases/metabolism
- Recurrence
- Ribosomal Protein S6 Kinases, 70-kDa/antagonists & inhibitors
- Signal Transduction/drug effects
- Sirolimus/administration & dosage
- Sirolimus/adverse effects
- Sirolimus/analogs & derivatives
- Sirolimus/therapeutic use
- T-Lymphocytes/immunology
- TOR Serine-Threonine Kinases
- Treatment Outcome
- Vasculitis, Leukocytoclastic, Cutaneous/chemically induced
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Affiliation(s)
- Karen W L Yee
- Authors' Affiliations: Departments of Leukemia and Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, Texas
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29
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Melloni G, Cremona G, Bandiera A, Arrigoni G, Rizzo N, Varagona R, Muriana G, Carretta A, Ciriaco P, Canneto B, Zannini P. Localized Organizing Pneumonia: Report of 21 Cases. Ann Thorac Surg 2007; 83:1946-51. [PMID: 17532376 DOI: 10.1016/j.athoracsur.2007.01.062] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 01/26/2007] [Accepted: 01/29/2007] [Indexed: 01/15/2023]
Abstract
BACKGROUND Thoracic surgeons have limited experience with treating localized organizing pneumonia owing to its rare occurrence in routine clinical practice. METHODS We retrospectively investigated the clinicopathologic features of 21 patients with localized organizing pneumonia observed between 2001 and 2004. RESULTS There were 15 men and 6 women. Mean age was 63 years. Eight patients (38%) were symptomatic. Computed tomographic scan showed a single lesion in 17 patients (12 nodules and 5 masses) and bilateral lesions in 4. Wedge resection was performed in 16 patients and lobectomy in 5. There was no operative mortality. Follow-up was complete in all patients (range, 2 to 46 months; median, 20 months). Surgery was curative in 15 of 17 patients with a single lesion, and no recurrence was observed (p < 0.005). The remaining 2 patients with a single lesion (2 masses) had a local relapse with the appearance of nodular lesions in the residual parenchyma. Both these patients received steroids with resolution of the lesions. All 4 patients with bilateral lesions who underwent surgery for diagnostic purposes received steroids with improvement of the radiologic aspect in 3 and stabilization of the lesions in 1. CONCLUSIONS Clinical and radiologic findings of localized organizing pneumonia are nonspecific, and this unusual entity is difficult to differentiate from a primary or metastatic tumor. Surgical resection allows both diagnosis and cure. However, considering the benignity of the lesion and the efficacy of steroids, major pulmonary resections should be avoided.
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Affiliation(s)
- Giulio Melloni
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy.
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30
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Moore SL. Bronchiolitis Obliterans Organizing Pneumonia: A Late Complication of Stem Cell Transplantation. Clin J Oncol Nurs 2007; 7:659-62. [PMID: 14705482 DOI: 10.1188/03.cjon.659-662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) is a late complication of hematopoietic stem cell transplantation. Many transplant recipients have returned to their community oncologists before BOOP has occurred. The etiology of BOOP in transplant recipients is not understood fully, but it may be associated with chronic graft-versus-host disease. BOOP presents both vague and common symptoms that can progress into respiratory failure but respond to early and appropriate treatment. Early recognition and treatment of BOOP are essential to improving survival of patients who are post-transplantation. Community oncology nurses are in a key position to support initiation of side-effect management. This article presents information about the etiology, presentation, diagnostic testing, and treatment of BOOP. Two case studies are included that illustrate the typical course of BOOP and its treatment.
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31
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Daniels CE, Myers JL, Utz JP, Markovic SN, Ryu JH. Organizing pneumonia in patients with hematologic malignancies: A steroid-responsive lesion. Respir Med 2007; 101:162-8. [PMID: 16704928 DOI: 10.1016/j.rmed.2006.03.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Revised: 03/13/2006] [Accepted: 03/27/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Organizing pneumonia (OP) is a distinct histopathologic lesion that occurs in a variety of clinical contexts. There have been occasional reports of OP occurring in patients with hematologic malignancies. STUDY OBJECTIVES To examine the association of OP with hematologic malignancies and to assess the clinical course of affected patients. DESIGN A retrospective review of our institutional experience of unexplained OP developing in patients with hematologic malignancies. SETTING Tertiary care, referral medical center. PATIENTS We identified 6 patients with a verified histopathologic diagnosis of OP and antecedent or concomitant diagnosis of a hematologic malignancy from the Mayo Clinic database (1995-2003). Clinical, radiologic, and outcome data were abstracted from records. RESULTS Underlying hematologic disorders included lymphoma (2), acute leukemia (2), cutaneous T-cell lymphoma (1), and myelodysplastic syndrome (1). OP was diagnosed by surgical lung biopsy in 4 and bronchoscopic biopsy in 2. Four of the 6 patients had previously been exposed to chemotherapeutic agents, two had not. Three of the 6 patients had bone marrow transplantation prior to development of OP. Five patients were treated with prednisone and all experienced symptomatic improvement with documented radiologic resolution in 4. One patient experienced symptomatic and radiologic resolution with observation alone. Three patients ultimately died from complications of their underlying hematologic disorder and 1 patient died of unknown causes. Two patients were alive without respiratory complaints more than 1 year after lung biopsy. CONCLUSIONS OP occurs in patients with underlying hematologic malignancies who may or may not have been treated with chemotherapy and responds favorably to corticosteroid therapy.
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Affiliation(s)
- Craig E Daniels
- Division of Pulmonary and Critical Care Medicine, Desk East 18, Mayo Clinic, Rochester, MN 55905, USA.
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32
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Cobo Dols M, Gil Calle S, Alés Díaz I, Villar Chamorro E, Alcaide García J, Gutiérrez Calderón V, Benavides Orgaz M. Bronchiolitis obliterans organizing pneumonia simulating progression in bronchioloalveolar carcinoma. Clin Transl Oncol 2006; 8:133-5. [PMID: 16632429 DOI: 10.1007/s12094-006-0171-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathologic syndrome with characteristic features. The diagnosis of BOOP requires the presence of a combination of pathological, clinical, and radiological features. We report the case of a lung cancer patient with bronquiloalveolar carcinoma (BAC) presenting with BOOP after chemotherapy with docetaxel and gemcitabine producing severe respiratory insufficiency, and simulating a progression of the tumor.
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Affiliation(s)
- Manuel Cobo Dols
- Servicio de Oncología Médica, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
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Abstract
In this comprehensive review, two very closely related interstitial pneumonias are discussed: the cryptogenic form of organizing pneumonia (COP); and secondary forms of organizing pneumonia (OP), which occur in association with identifiable medical conditions. Some newer and lesser known of these associated conditions are described, most importantly post-radiation OP.Rapidly progressive, corticosteroid-resistant and poor prognostic forms of OP have been described. These types purportedly occur more frequently in secondary OP. However, OPs frequently coexist with other interstitial pneumonias, especially when associated with connective tissue diseases. Therefore, tissue sampling error or an incorrect morphologic diagnosis can be the basis for the occurrence of clinically aggressive OPs. By using the 2002 American Thoracic Society/European Respiratory Society diagnostic criteria, some pre-2002 cases reported as OP would be re-classified today.Although COP is considered to have a good prognosis and to be corticosteroid responsive, approximately 70% of patients, treated with corticosteroids, relapse even during initial treatment. Multiple and late relapses occur in about one-third of the patients. We performed a meta-analysis of second-line treatment options for corticosteroid-refractory forms of OP. Three alternative nonsteroid agents - cyclophosphamide, azathioprine, and cyclosporin - have been used in combination with corticosteroids. On careful review, in a number of cases reported as secondary OP, other histologic interstitial patterns besides OP were described. The need for second-line therapy in these patients might have been dictated by the non-organizing pneumonic component. Most of the scant number of reports come from outside the US. World experience with these is limited, but good clinical outcomes have been noted, even in patients with interstitial patterns in addition to OP.The initiation of the OP tissue response in the bronchiolar and sub-bronchiolar location may be due to the presence of bronchiolar-associated lymphoid tissue found at the bifurcations of the bronchioles. Inhaled antigens stimulate granulocyte colony stimulating factor-mediated airway inflammation, followed later by CD44-mediated clearance. Repair requires intrabronchiolar formation of granulation tissue and a favorable ratio of matrix metalloproteinase to tissue inhibitors of metalloproteinase (MMP : TIMP) within the stroma. This reparative milieu allows extracellular matrix degradation and re-synthesis to occur. MMP-expressing fibroblasts then phagocytose the collagen fibrils and microfibrils produced earlier in repair, reversing the initial fibrosis.
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Stover DE, Mangino D. Macrolides: a treatment alternative for bronchiolitis obliterans organizing pneumonia? Chest 2005; 128:3611-7. [PMID: 16304320 DOI: 10.1378/chest.128.5.3611] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Some macrolides have been found to exert anti-inflammatory effects. Lung diseases such as asthma, panbronchiolitis, cystic fibrosis, and bronchiectasis are thought to respond to the immunomodulatory properties of macrolides. We report three cases of idiopathic bronchiolitis obliterans organizing pneumonia, now called cryptogenic organizing pneumonia, and three cases of radiation-related bronchiolitis obliterans organizing pneumonia that responded to macrolide therapy. An explanation of why macrolides may have anti-inflammatory effects in patients with these syndromes is discussed. These cases help to reinforce accumulating data that macrolides are beneficial as anti-inflammatory agents and organizing pneumonia may be another pulmonary disease that can benefit from such therapy.
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Affiliation(s)
- Diane E Stover
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Macartney C, Burke E, Elborn S, Magee N, Noone P, Gleadhill I, Allen D, Kettle P, Drake M. Bronchiolitis obliterans organizing pneumonia in a patient with non-Hodgkin's lymphoma following R-CHOP and pegylated filgrastim. Leuk Lymphoma 2005; 46:1523-6. [PMID: 16194900 DOI: 10.1080/10428190500144615] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) presents with fever, dyspnoea, pleuritic chest pain and hypoxia. The diagnosis can be made from radiological appearances on chest radiograph and CT scan correlated with histological findings following biopsy. We present a 52-year-old gentleman undergoing treatment for high grade non-Hodgkin's lymphoma who developed respiratory symptoms during chemotherapy. BOOP was diagnosed and he responded well to oral prednisolone. The cause of BOOP is often not certain. However, in this case we suspect pegylated filgrastim or rituximab as possible agents.
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MESH Headings
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Biopsy
- Cryptogenic Organizing Pneumonia/chemically induced
- Cryptogenic Organizing Pneumonia/diagnostic imaging
- Cryptogenic Organizing Pneumonia/etiology
- Cryptogenic Organizing Pneumonia/pathology
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Drug Therapy, Combination
- Filgrastim
- Granulocyte Colony-Stimulating Factor/adverse effects
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Humans
- Immunotherapy
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Polyethylene Glycols
- Prednisolone/therapeutic use
- Radiography
- Recombinant Proteins
- Rituximab
- Tomography Scanners, X-Ray Computed
- Vincristine/therapeutic use
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Affiliation(s)
- C Macartney
- Department of Haematology, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
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Abstract
PURPOSE OF REVIEW Basic information as well as more recent concepts regarding cryptogenic organizing pneumonia and secondary forms of the disease. RECENT FINDINGS More recently described and less well recognized illnesses associated with organizing pneumonia, such as organizing pneumonia associated with radiation, are enumerated. In vitro studies from separate laboratories are integrated to create a proposed model of the pathogenesis and repair mechanisms that occur in organizing pneumonias. Using current criteria, we note other interstitial lung processes, in addition to organizing pneumonia, are present in some earlier reports. SUMMARY Cryptogenic organizing pneumonia has been reported to respond to corticosteroids with clinico-radiographic resolution in 70-80% of cases. Treatment duration is lengthy, and despite this, recurrences and late recurrences are common. Rapidly progressive, steroid resistant and poor prognostic forms of organizing pneumonia have been described and have been reported more frequently with secondary organizing pneumonia. Since other histologic interstitial patterns often coexist with organizing pneumonia, tissue sampling error or an incorrect morphologic diagnosis can be the reason for aggressive clinical behavior. Steroid nonresponsive patients have been treated with secondary non-steroidal agents. Good clinical outcomes have been reported. Inhaled antigens stimulate GM-CSF-mediated airway inflammation in organizing pneumonia. Repair requires the following: granulation tissue, upon which re-epithelialization occurs; a favorable stromal ratio of matrix metalloproteinase to tissue inhibitors of metalloproteinase; concurrent resolution of inflammation; and stromal fibroblast ingestion of collagen produced earlier in repair, reversing the initial fibrosis.
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Affiliation(s)
- Cory Schlesinger
- Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
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Oymak FS, Demirbaş HM, Mavili E, Akgun H, Gulmez I, Demir R, Ozesmi M. Bronchiolitis obliterans Organizing Pneumonia. Respiration 2005; 72:254-62. [PMID: 15942294 DOI: 10.1159/000085366] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2003] [Accepted: 08/26/2004] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Bronchiolitis obliterans organizing pneumonia (BOOP) may be classified as cryptogenic (idiopathic) and secondary. There are no clear clinical and radiological features distinguishing between idiopathic and secondary BOOP. OBJECTIVES To analyze the etiologic factors, clinical and radiological features, diagnostic approach and response to therapy at onset and outcome in subjects with BOOP. METHODS The medical files of Erciyes University Hospital from 1995 to 2003 were retrospectively reviewed. Patients with biopsy-proven BOOP were selected for evaluation. The etiology and initial features of BOOP, treatment, resolution, relapse, and survival were obtained from medical records, and a follow-up patient questionnaire. RESULTS We have diagnosed 26 cases (13 males /13 females) with BOOP syndrome (mean age 54 +/- 15 years, range 14-93). More than half the patients (58%) were classified as idiopathic BOOP. Patients presented with cough (92%), dyspnea (70%), pleuritic chest pain, hemoptysis and fever (50%). The biopsy specimens had been obtained by transbronchial and/or transthoracic lung biopsy in 18 cases (69%). At radiological evaluation, there were bilateral patchy alveolar and/or interstitial infiltrates in 16 patients (62%), and solitary pneumonic involvement in 10 patients (38%). Three patients recovered spontaneously, 5 remained cured after resection of the focal lesion. Corticosteroid therapy was given in 17 patients (65%). Apart from four patients who died (death was attributable to BOOP in only 1 patient) and three patients who relapsed, the prognosis was good in all patients. CONCLUSIONS The etiology of BOOP is usually idiopathic. We observed that hemoptysis and pleuritic chest pain were a relatively frequent symptom in BOOP in the present series, in contrast to previous observations. The diversity of radiological and clinical presentations including hemotysis and pleuritic chest pain should prompt consideration of the diagnosis in patients with persisting pulmonary symptoms and radiological findings.
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Affiliation(s)
- F Sema Oymak
- Department of Chest Disease, Erciyes University Medical Faculty, Talas/Kayseri, Turkey
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Abstract
Organising Pneumonia (formerly called Bronchiolitis Obliterans with Organising Pneumonia) is a particular form of inflammatory and fibroproliferative lung disease. Its idiopathic form called Cryptogenic Organising Pneumonia, was recently defined by an ATS/ERS consensus conference. The disease onset is subacute with cough, dyspnea, fever, asthenia, weight loss, crackles, and elevation of biological inflammatory markers. Bronchoalveolar lavage reveals a mixed alveolitis with elevated lymphocyte, neutrophil, and eosinophil counts. Chest imaging usually shows multifocal alveolar opacities predominating in the subpleural regions, often with a migratory pattern. Lung biopsy reveals budding connective tissue filling the distal airspaces. Diagnosis is established by combining clinical, radiological and histological criteria. Similarities with other disease processes can lead to delayed or erroneous diagnosis. Most patients respond well to corticosteroid therapy. Relapses are frequent but can generally be controlled with moderate doses of prednisone and do not worsen the prognosis. The therapeutic strategy aims at reducing the steroid doses while maintaining an optimal disease control.
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Affiliation(s)
- Romain Lazor
- Service de Pneumologie, BHH C, Inselspital - Hôpital Universitaire de Berne, CH-3010 Berne, Suisse
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40
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Abstract
Cryptogenic organizing pneumonia is a rare, distinct disorder that is sufficiently different from the other diseases in the group of idiopathic interstitial pneumonias to be designated as a separate entity. In its most typical presentation, it is characterized by dyspnea and cough, with multiple patchy alveolar opacities on pulmonary imaging. Definite diagnosis is obtained by the finding of buds of granulation tissue in the distal airspaces at lung biopsy. No cause (as infection, drug reaction, or associated disease as connective tissue disease) is found. Corticosteroid treatment is rapidly effective, but relapses are common on reducing or stopping treatment.
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Affiliation(s)
- Jean-François Cordier
- Department of Respiratory Medicine and Center for Orphan Lung Diseases, Louis Pradel Hospital, Claude Bernard University, 28 Avenue Doyen Lépine, 69677 Lyon (Bron), France.
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Addor G, Monteiro AS, Nigri DH, Torres W, Franco CADB. Bronquiolite obliterante com pneumonia em organização. J Bras Pneumol 2004. [DOI: 10.1590/s1806-37132004000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Uma paciente 48 anos apresentou-se, assintomática, mas com achado radiológico de condensações alveolares, algumas constituindo nódulos em lobo superior direito, lobo médio e língula com predomínio perihilar. Foi considerado o diagnóstico diferencial de neoplasia, sarcoidose, doenças granulomatosas e tuberculose, entre outras doenças. O diagnóstico de bronquiolite obliterante com pneumonia em organização foi estabelecido através de videotoracoscopia e foi iniciado o tratamento com esteróides. Houve boa evolução com resolução radiológica.
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Song J, Gorgan L, Corkey R, Kwa SLC. An Unusual Case of Bronchiolitis obliterans Organizing Pneumonia Concomitant with Bronchioloalveolar Carcinoma. Respiration 2004; 71:95-7. [PMID: 14872120 DOI: 10.1159/000075658] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2003] [Accepted: 04/08/2003] [Indexed: 11/19/2022] Open
Abstract
Although bronchiolitis obliterans organizing pneumonia (BOOP) has been associated with a variety of underlying disorders, the majority of cases of BOOP are idiopathic. We present the case of a 61-year-old patient with fever, dry cough, bilateral patchy consolidation and high erythrocyte sedimentation rate. Open lung biopsy shows coexistence of BOOP and bronchioloalveolar carcinoma. It is interesting that both diseases are predominantly air space diseases and present similar radiologic features making the diagnosis and follow-up of treatment more difficult.
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Affiliation(s)
- Jungsik Song
- Department of Medicine, MetroWest Medical Center, Framingham, MA 01702, USA
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Coexistencia de bronquiolitis obliterante con neumonía organizada y carcinoma broncogénico en zonas pulmonares distantes. Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75490-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ho JC, Ooi GC, Mok TY, Chan JW, Hung I, Lam B, Wong PC, Li PC, Ho PL, Lam WK, Ng CK, Ip MS, Lai KN, Chan-Yeung M, Tsang KW. High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome. Am J Respir Crit Care Med 2003; 168:1449-56. [PMID: 12947028 DOI: 10.1164/rccm.200306-766oc] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The treatment of atypical pneumonia, subsequently termed severe acute respiratory syndrome (SARS), is controversial, and the efficacy of corticosteroid therapy is unknown. We have evaluated the clinical and radiographic outcomes of 72 patients with probable SARS (median age 37 years, 30 M), who received ribavirin and different steroid regimens in two regional hospitals. Chest radiographs were scored according to the percentage of lung field involved. Seventeen patients initially received pulse steroid (PS) (methylprednisolone > or =500 mg/day) and 55 patients initially received nonpulse steroid (NPS) (methylprednisolone <500 mg/day) therapy. The cumulative steroid dosage; intensive care unit admission, mechanical ventilation, and mortality rates; and hematologic and biochemical parameters were similar in both groups after 21 days. However, patients in the PS group had less oxygen requirement, better radiographic outcome, and less likelihood of requiring rescue PS therapy than their counterparts. There was no significant difference between the two groups in hemolytic anemia, severe secondary infections, or hematemesis, but patients in the PS group had less hyperglycaemia. Initial use of pulse methylprednisolone therapy appears to be a more efficacious and an equally safe steroid regimen when compared with regimens with lower dosage and should be considered as the preferred steroid regimen in the treatment of SARS, pending data from future randomized controlled trials.
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Affiliation(s)
- James C Ho
- University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, People's Republic of China
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