Patterns of lung involvement by malignant lymphoma.

Abstract

Recent evidence has suggested that the anatomic distribution of malignant lymphomas may reflect important differences in biologic behavior. To determine if the anatomic distribution of malignant lymphomas in the lung correlated with the disease course, we examined the pattern of lung involvement in patients with Hodgkin's and non-Hodgkin's lymphomas. We reviewed the medical records of 651 patients with a diagnosis of malignant lymphoma and identified 54 patients with histologically documented lung involvement. Based on radiologic and surgical findings, these patients had lung involvement characterized as either (1) bronchovascular-lymphangitic, (2) nodular, or (3) alveolar. The pattern of lung involvement was correlated with clinical manifestations and disease course. Distinct clinical courses were associated with these three patterns of lung involvement. In contrast, traditional histopathologic classification did not correlated with the pattern of lung involvement was a poor prognostic factor and was associated with a median survival of 12 1/2 months. Pleural effusions eventually developed in 24 patients and were associated with a median survival of only 3 months. These findings suggest that the anatomic pattern of lung involvement is a measure of biologic behavior and may be a useful variable in the staging of patients with malignant lymphoma.