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Imaging |

Rare Cresentic Shaped Radiographic Findings of Organizing Pneumonia Associated With Cutaneous T-Cell Lymphoma

Michael Markos*, MD; Daisuke Takekoshi, MD; Min Joo, MD
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University of Illinois at Chicago, Chicago, IL


Chest. 2012;142(4_MeetingAbstracts):554A. doi:10.1378/chest.1390255
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Abstract

SESSION TYPE: Imaging Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Organizing pneumonia has a distinct histopathologic pattern that may be encountered in a variety of medical conditions including malignancy.

METHODS: A 53 year old woman with biopsy diagnosed primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, presented for evaluation of abnormal imaging of the chest discovered during staging CT of the chest. The CT scan yielded numerous opacities diffusely scattered throughout bilateral lung fields. The opacities exhibited multiple crescents of consolidation otherwise known as “atoll” sign or reverse halo sign. The patient’s medical history is significant for controlled hypertension; she is a never smoker. The patient denied any pulmonary complaints. Her review of systems was significant for an intentional thirty pound weight loss in eight months.

RESULTS: Bronchoscopy with transbronchial biopsy exhibited fragments of bronchial epithelium and alveolar tissue with few lymphoid aggregates composed of small mature lymphocytes. No definitive morphologic or immunophenotypic evidence of T-cell lymphoma was noted on transbronchial biopsy and an infectious etiology was not identified. Repeat CT scan six months later showed significant increase in the numbers of similar abnormal lesions and the patient was referred for video assisted thoracoscopic biopsy. Surgical biopsy yielded histologic evidence of organizing pneumonia with intraluminal organizing fibrosis nodules in distal airpaces, patchy distribution, preservation of lung architecture. Further histopathology exhibited fragments of bronchial epithelium, alveolar tissue with few lymphoid aggregates composed of small mature lymphocytes. Immunohistochemical stains and flow cytometry were negative for immunophenotypic evidence of T-cell lymphoma and associated with reactive T-cell infiltrates.

CONCLUSIONS: Following surgical biopsy histopathologic, immunohistochemical, and infectious work-up, the diagnosis of secondary organizing pneumonia was made. The patient was started on systemic steroids with prednisone 60mg daily. Repeat CT scan one and half months post steroid therapy yielded a marked improvement and with almost complete resolution in most of the lesions and pulmonary nodules.

CLINICAL IMPLICATIONS: Organizing pneumonia (OP) has been reported in patients with hematologic malignancies and has been found to be steroid responsive. Biopsy diagnosis is essential and impacts prognosis and staging.

DISCLOSURE: The following authors have nothing to disclose: Michael Markos, Daisuke Takekoshi, Min Joo

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University of Illinois at Chicago, Chicago, IL

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