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Am. J. Respir. Crit. Care Med., Volume 158, Number 4, October 1998, 1221-1229

AIDS-related Primary Pulmonary Lymphoma

PATRICK RAY, MARTINE ANTOINE, MURIELLE MARY-KRAUSE, MARIE-GISÈLE LEBRETTE, MARIE WISLEZ, CLAUDINE DUVIVIER, MARIE-CAROLINE MEYOHAS, PIERRE-MARIE GIRARD, CHARLES MAYAUD, and JACQUES CADRANEL

Services de Pneumologie et de Réanimation Respiratoire et Service d'Anatomie-Pathologique, Hôpital Tenon; Laboratoire de Biologie et d'Immunopathologie Pulmonaire UPRES EA 1531, Université Paris VI, UFR Saint-Antoine; B3E-INSERM SC4, UFR Saint-Antoine; Service des Maladies Infectieuses, Hôpital Rothschild; and Service de Médecine Interne et Service des Maladies Infectieuses, Hôpital Saint-Antoine, Paris, France

We describe 12 cases of AIDS-related primary pulmonary lymphoma occurring between 1986 and 1996 in a large French cohort of HIV-infected patients. Diagnostic criteria were: (1) histologically proven lymphomatous pulmonary involvement; (2) absence of mediastinal and/or hilar adenopathy on chest radiography; (3) absence of extrathoracic lymphoma extension. All patients were severely immunodeficient at the time of diagnosis. All but one patient presented with B and/or nonspecific respiratory symptoms. Chest radiography showed one or more marginated nodule(s) or large mass. CT scan showed a cavitary lesion in five patients. No lymph node enlargement or specific pleural effusion was detected. Transthoracic needle biopsies were performed in 10 patients and avoided open-lung biopsy for the diagnosis of lymphoma in five patients. All but one of the primary pulmonary lymphoma were high-grade B-cell non-Hodgkin's lymphomas. Using antilatent membrane protein-1 antibodies and an Epstein-Barr-Virus-encoded RNA transcript-specific probe, latent EBV infection of tumor cells was demonstrated in every case. All but one of the patients received chemotherapy. The median survival time was 4 mo, and no patient was still alive at the cut-off date for this analysis. Progessive pulmonary lymphoma was the main cause of death, but infections were also frequent.




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