Journal Reading

RADIOLOGIC FEATURES OF LUNG INVOLVEMENT

BY LYMPHOMA
M. R. L. pedreira, P. Cartón Sánchez, N. Andres Garcia, L. Casadiego Matarranz, R.
Esteban Saiz, I. Sánchez Lite, R. Petruzzella Lacave, M. Rodriguez Velasco, E. C.
Gonzalo; Valladolid/ES

Penyaji :
dr. Vivid Umi Varidha

Pembimbing :
Dr. Anita Widyoningroem,Sp.Rad (K)

1
Learning objectives

• To make a review of lung involvement in the

different types of lymphoma.
• To demonstrate the broad spectrum of radiologic
manifestations and recognize most common
radiological patterns.
• To make a differential diagnosis.

2
Background

• The diagnosis of lymphoma can be difficult to make

when a biopsy specimen is small.
• The imaging characteristics are frequently non-
specific.
• It is valuable to understand the broad spectrum of
imaging patterns in pulmonary lymphoproliferative
diseases
• Reviewed the radiological findings in simple x-ray
and CT scan of multiple patients with histologic
confirmatory

3
Definition

• Pulmonary lymphoproliferative diseases are

characterized for lymphoid cells proliferation and
lung parenchymal infiltration by cells of the
lymphoid series.
• This cell proliferation can be benign or malignant.

4
Classification
Benign or reactive Malignant
Pulmonary nodular lymphoid Primary lung lymphoma (1)
hyperplasia

Follicular bronchiolitis Secondary involvement of the

lung (2):
- Hodgkin disease (HL)
- Non-Hodgkin lymphoma
(NHL)
Lymphocytic interstitial Immunocompromised
pneumonia pacient´s lymphomas (3)
- AIDS related lymphoma
- Lymphoma in transplanted
patients 5
Primary pulmonary lymphoma (PPL….1)
• Lung involvement by monoclonal lymphoid
proliferation, without extrathoracic disease for at
least three months after diagnosis
• Very rare (< 1% of lymphoproliferative diseases).
• Classification:
- Low grade Bcell lymphoma:BALToma/MALToma
- High grade lymphoma : Diffuse B cell lymphoma
- Lymphomatoid granulomatosis

6
Radiologic finding
Primary pulmonary lymphoma (PPL)
Low grade or BALToma : (Fig 1-4)
- Multiple nodules or areas of consolidation (70%)
- Air bronchogram (more than 50%)
- Single nodule or focal consolidation
- Interlobular septal thickening, centrilobular
micronodules and bronchial wall thickening (25%)
- Pleural effusion (10%) and lymphadenopathy (5-
30%) are uncommon

7
High grade : (Fig.5-7)
• Cavitation is a usual feature
• Single or multiple nodules/masses
• Consolidation or diffuse reticulonodular pattern are
less common.

Lymphomatoid granulomatosis :
• Multiple ill defined nodules with lower lobes
predominance, rapid progress and sometimes with
cavitation.
• It looks like Wegener disease

8
PPL low grade

9
10
11
12
PPL high grade

13
14
Secondary lung lymphoma… 2
Hodgkin Lymphoma: (Fig 8-13)
- 10%, recurrent, lung involvement (stage IV) 
worse prognosis
- Radiological finding :
1. Direct lung extension from hilar or mediastinal
nodal disease : perihilar opacities, interlobular
septal thickening
2. Single or multiple pulmonary nodules or
pulmonary consolidations, air bronchogram,
cavitation
3. Other findings: Atelectasis, Lipoid pneumonitis
caused by bronchial obstruction, Pleural effusion,
pleural masses. 15
Hodgkin lymphoma

16
17
18
19
20
Non-HL : (Fig. 14-22)
- The frequency of pulmonary involvement is 30%
- Radiologic findings:
1. Single or multiple nodules sharply or ill defined,
with variable size
2. Masses or "mass-like" consolidation with air
bronchogram (mimic pneumonia) and segmental
atelectasis.
3. Peribronchial and perivascular interstitial disease,
mimicking lymphangitis: bronchovascular
thickening, interlobular septal thickening,
centrilobular nodules and ground glass opacities.
4. Mediastinal lymphadenopathy (less common)
21
Non Hodgkin Lymphoma

22
23
24
25
26
27
28
29
30
Immunocompromised pacient´s lymphoma. 3
(Fig 23-24)
1. AIDS related lymphoma (ARL)
- Cause of death in up to 20% of HIV infected patients
- Associated with very low CD4 cell counts
Radiological finding :
1. Multiple pulmonary nodul
2. Pleura/Pericardial effusion Triad
3. Lymphadenopathy
4. Less common: focus of consolidation or ground
glass opacity

31
2. Transplanted patient lymphoma (TPL)
- < 2 % The majority of cases occur within two
years of transplantation
- The clinical presentation is variable (fever,
lymphadenopathy, abdominal pain)
- Radiologis finding :
1. Multiple nodules, ill defined, sometimes "halo
sign“
2. Mediastinal and hilar adenopathy (30- 60%)
3. Patchy airspace consolidation or ground glass
opacity
4. Septal thickening
32
33
34
 Differential diagnosis

Patients previously diagnosed of

lymphoma + new pulmonary lesion

Patients without a previous

lymphoproliferative

35
 That is why almost always a clinical,
microbiological and histological confirmation
will be needed.
36
37
38
Conclusion
• There are 4 radiological characteristic patterns :
1. Nodules
2. Masses or consolidation
3. Direct spread from mediastinum
4. Interstitial pattern
• Pulmonary involvement is more commonly seen in
secondary lymphoma (Hodgkin and non-Hodgkin).
• Primary pulmonary lymphoma and benign forms
are rare.

39
• Lung involvement worsens the prognosis  the
histologic grade have more influence than
pulmonary disease
• There are some characteristic radiological findings,
although the broad spectrum of radiological
presentations
• The majority of those with clinically or
radiologically suspected lymphoproliferative disease
still usually require a histological sample to confirm
the diagnosis and define the treatment options

40
41