PATTERNS OF LUNG INVOLVEMENT BY MALIGNANT-LYMPHOMA

Background. Recent evidence has suggested that the anatomic distributi on of malignant lymphomas may reflect important differences in biologi c behavior. To determine if the anatomic distribution of malignant lym phomas in the lung correlated with the disease course, we examined the pattern of lung involvement in patients with Hodgkin's and non-Hodgki n's lymphomas. Methods. We reviewed the medical records of 651 patient s with a diagnosis of malignant lymphoma and identified 54 patients wi th 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) alveol ar. The pattern of lung involvement was correlated with clinical manif estations and disease course. Results. Distinct clinical courses were associated with these three patterns Of lung involvement. In contrast, traditional histopathologic classification did not correlate with the pattern of lung involvement or the disease course in these 54 patient s. An alveolar pattern of lung involvement was a poor prognostic facto r 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. Conclusions. These findings sugge st that the anatomic pattern of lung involvement is a measure of biolo gic behavior and may be a useful variable in the staging of patients w ith malignant lymphoma.