ObjectiveTo highlight the characteristics of pulmonary MALT lymphoma with diffuse lung disease. MethodsThe clinical,radiological and pathological data of two patients with pulmonary MALT lymphoma were analyzed,and relevant literature was reviewed. ResultsOne patient was a 59-year-old male with cough for five years while antibiotic treatment was ineffective. The chest CT scan demonstrated diffuse lung disease,bilateral multiple consolidation and ground-glass opacities,small nodules and bronchiectasis. Thoracoscopy biopsy was performed and the pathology study confirmed the diagnosis of MALT lymphoma. Another case was a 50-year-old female,who suffered from fever,cough and dyspnea. The chest CT scan revealed bilateral multiple patchy consolidation,with air bronchogram. The eosinophils count in blood was high. Diagnosed initially as eosinophilic pneumonia,she was treated with corticosteroids. The clinical symptoms were improved,but the CT scan revealed no change. After the computed tomography guided percutaneous lung biopsy,pathological examination confirmed the diagnosis of MALT lymphoma. ConclusionMALT lymphoma with diffuse lung disease is rare and easy to be misdiagnosed. The positive rate of bronchoscopy is low and percutaneous lung biopsy or thoracoscopy biopsy is more useful for diagnosis.
ObjectiveTo improve clinicians' knowledge of hypersensitivity pneumonitis (HP). MethodsWe retrospectively analyzed the clinical data of 24 HP patients who were diagnosed in the Affiliated Drum Tower Hospital of Nanjing University Medical School during February 2005 to February 2013. The clinical,radiological and pathological features of those patients were summarized. ResultsAmong those 24 patients,15 were male and 9 were female,with mean age of (48±13) years. All patients had a history of environmental exposure. Two patients showed acute clinical manifestations,and there were 17 subacute and 5 chronic cases. The main clinical manifestations were dyspnea,cough,sputum,fever and weight loss with hypoxemia via blood gas analysis. Restrictive ventilatory impairment was the most frequent functional pattern,and the carbon monoxide diffusing capacity was decreased. Pulmonary function test showed restrictive ventilatory defect and gas interchange disturbance. The features of chest HRCT included diffuse ground-glass attenuation and/or patchy consolidation,centrilobular micronodules,mosaic sign,reticular and/or honeycombing lesions. Bronchoalveolar lavage fluid (BALF) demonstrated an increase of total cell counts with predominant lymphocytosis. The transbronchoscopic lung biopsy (TBLB) pathological examination revealed lymphocytic alveolitis,noncaseating granuloma,and interstial pneumonia. All patients were treated by corticosteroid and avoided antigen exposure and showed significant clinical and radiological improvement. ConclusionThe diagnosis of HP is difficult. In most cases (acute and subacute HP),a diagnosis can be made by combination history of exposure,chest HRCT manifestations,cell classification of BALF and pathological examination of TBLB. For atypical cases (chronic HP),a surgery lung biopsy is needed for multi-disciplinary diagnosis including pathologist,radiologist and pulmonologists.