Combined detection of lymphocyte clonality and MALT1 translocations in bronchoalveolar lavage fluid for diagnosing pulmonary lymphomas

Diagnosis of pulmonary lymphoma using small tissue samples is difficult and often requires surgical procedures; thus, a less invasive sampling method is desirable. We previously showed that pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma can be diagnosed by detecting MALT lymphoma translocation gene 1 (MALT1) translocations in bronchoalveolar lavage fluid (BALF) cells. Analysis of B-cell clonality based on immunoglobulin heavy chain (IGH) gene rearrangements was also reportedly useful for diagnosing pulmonary lymphoma. The aim of this prospective multicenter study was to evaluate the yet unknown diagnostic potential of combined detection of MALT1 translocations and clonality using BALF. We analyzed B- and T-cell clonality based on IGH and T-cell receptor (TCR) rearrangements together with MALT1 translocations using BALF of patients with clinically suspected pulmonary lymphomas. In total, 39 patients were evaluated and categorized into three groups: B-cell lymphoma, lymphoproliferative disorders, and other diseases. IGH rearrangement detection for B-cell lymphoma diagnosis exhibited sensitivity and specificity of 88.9% and 90.0%, respectively. TCR rearrangements were not observed in patients with B-cell lymphomas. The presence of IGH rearrangements together with the absence of TCR rearrangements indicated 96.0% specificity for the diagnosis of B-cell lymphoma. The sensitivity and specificity of MALT1 translocations for diagnosing MALT lymphoma were 28.6% and 100%, respectively. The combined detection of lymphocyte clonality and MALT1 translocations using BALF is suitable for screening and diagnosis of B-cell lymphomas. Analysis of specific genes such as MALT1 should improve the precision of B-cell lymphoma diagnosis.

Radiomics for Everyone: A New Tool Simplifies Creating Parametric Maps for the Visualization and Quantification of Radiomics Features

Aim was to develop a user-friendly method for creating parametric maps that would provide a comprehensible visualization and allow immediate quantification of radiomics features. For this, a self-explanatory graphical user interface was designed, and for the proof of concept, maps were created for CT and MR images and features were compared to those from conventional extractions. Especially first-order features were concordant between maps and conventional extractions, some even across all examples. Potential clinical applications were tested on CT and MR images for the differentiation of pulmonary lesions. In these sample applications, maps of Skewness enhanced the differentiation of non-malignant lesions and non-small lung carcinoma manifestations on CT images and maps of Variance enhanced the differentiation of pulmonary lymphoma manifestations and fungal infiltrates on MR images. This new and simple method for creating parametric maps makes radiomics features visually perceivable, allows direct feature quantification by placing a region of interest, can improve the assessment of radiological images and, furthermore, can increase the use of radiomics in clinical routine.

Analysis of Clinical Features, Pathological Features and Misdiagnosis of Pulmonary Lymphoma

Primary pulmonary lymphoma is a relatively rare extranodal lymphoma, and the incidence rate has increased in recent years. In the past, the disease mainly relied on surgery to obtain the pathological basis, so the clinical misdiagnosis rate was high. How to improve its early diagnosis and treatment has attracted much attention. By exploring the imaging manifestations of primary pulmonary lymphoma, we can further understand and improve the imaging diagnosis level of primary pulmonary lymphoma. This paper discusses the classification, imaging manifestations, diagnosis and identification of pulmonary lymphoma. The clinical data and imaging findings of primary pulmonary lymphoma diagnosed in a hospital were retrospectively summarized, and their imaging features were analyzed. We observe the clinicopathological characteristics and immunohistochemical phenotypes of multiple masses with cavitation type primary lung lymphoma, and analyze the virus and imaging characteristics of hybridization. The results of the study show that the CT (Computed Tomography) manifestations of primary lung lymphoma are diverse. The characteristics of cross-leaf distribution are more characteristic, and enhanced scanning lesions are usually mild to moderate. In the case of simultaneous masses and pneumonialike consolidation in the lungs, this disease needs to be considered.

Computed Tomography Analysis Based on Imaging Manifestations of Pulmonary Lymphoma

Objective: The imaging manifestations of lung lymphoma are complex and diverse. This paper discusses the pathological features of lung lymphoma and improves the clinical and radiologist’s understanding of the disease. Methods: Retrospective analysis of chest computed tomography (CT) image data of 58 patients with pulmonary lymphoma confirmed by clinical and histopathology. Results: CT diagnosis of 35 cases of pulmonary lymphoma, including 13 cases of mass nodular type, 15 cases of pneumonia consolidation type, 7 cases of mixed type, and the diagnostic accuracy rate was 60.34%. Airborne bronchial signs, normal vascular crossing signs, coexisting signs of multiple types of lesions, cross-lobe distribution signs, and ground glass signs are typical CT signs of pulmonary lymphoma. The average value of CT vital signs changes of the five types of lung lymphomas is 18%. The scan completion rate is 81%. The number of patients with five types of lung lymphoma were 17 cases of age <35 years old, and 18 cases for age >35 years old, with a balanced age distribution. Conclusions: CT examination is helpful for the diagnosis and differential diagnosis of pulmonary lymphoma.

A Retrospective Study on Clinical Significance of Imaging And Endobronchial Features In Pulmonary Lymphoma Diagnosed By Bronchoscopy: When Should We Perform Bronchoscopy?

Background: Pulmonary lymphoma is rare while the radiographic lesions are nonspecific. The use of bronchoscopy, is controversial, and may be of limited diagnostic value for pulmonary lymphoma diagnosis.Methods: Cases of pulmonary lymphoma diagnosed by bronchoscopy were retrospectively reviewed from January 2010 till December 2020. Clinico-radiological records of these cases were retrieved and bronchoscopy was performed with histopathological evaluation of the biopsy specimens. Results: Of the 41 cases included in our study, 20 were primary pulmonary lymphoma. The majority of subtypes were diffuse large B-cell lymphoma(43.9%) and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue lymphoma(29.3%), with high percentage of underlying chronic disease. The common Computed Tomography(CT) abnormalities were mass(43.9%), consolidation(24.4%) or ground-glass opacities(24.4%). To evaluate the pulmonary lesions distribution, 41.5% patients had segmental lesions, 29.3% presences of diffuse lesions, 17.1% of local lesions and 12.2% of hilar lesions, with the maximal value of standard uptake value (SUVmax) median value of 9.6. At bronchoscopy, 41.5% lesions were identified as focal solitary mass, 22% were normal, 17.1% were mucosae asperity or edema, 9.8% were diffuse airway submucosal nodules or thickening and 9.8% were bronchiole stenosis, while certain endobronchial patterns may correspond to specific imaging features. Conclusion: The imaging features and endobronchial patterns of pulmonary lymphoma are characteristic. Bronchoscopy is still a useful tool, that is minimally invasive, to diagnose pulmonary lymphoma, while accurate analysis of the clinico-radiological records is essential before such procedure.

Hammering home the sickle: an instructive case of endobronchial anaplastic large cell lymphoma

It is extremely unusual for primary pulmonary lymphoma, an uncommon occurrence in any form, to be of T-cell origin and to manifest as an endobronchial lesion. Each of these characteristics is rare individually, so cases that combine them are exceptional. We report a patient in whom primary pulmonary anaplastic large cell lymphoma, a T-cell neoplasm, presented with obstruction of the left upper lobe bronchus, resulting in left upper lobe atelectasis and creating the radiographic luftsichel sign. We briefly discuss anaplastic large cell lymphoma as a whole, place our case in the context of previously published literature on endobronchial anaplastic large cell lymphoma, and review the genesis of the luftsichel sign.

Significance of Imaging and Clinical Features in Pulmonary Lymphoma Diagnosed by Bronchoscopy

Background: Pulmonary lymphoma is rare while the radiographic lesions are nonspecific. The use of bronchoscopy, the first-line procedure, is controversial, and may be of limited diagnostic value for pulmonary lymphoma diagnosis. Methods: Cases of pulmonary lymphoma diagnosed by bronchoscopy were retrospectively reviewed from January 2010 till December 2020. Clinico-radiological records of these cases were retrieved and bronchoscopy was performed with histopathological evaluation of the biopsy specimens. Results: Of the 41 cases included in our study, 20 were primary pulmonary lymphoma. The majority of subtypes were diffuse large B-cell lymphoma(43.9%) and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue lymphoma(29.3%), with high percentage of underlying chronic disease. The common Computed Tomography(CT) abnormalities were mass(43.9%), consolidation(24.4%) or ground-glass opacities(24.4%). To evaluate the pulmonary lesions distribution, 41.5% patients had segmental lesions, 29.3% presences of diffuse lesions, 17.1% of local lesions and 12.2% of hilar lesions, with the maximal value of standard uptake value (SUVmax) median value of 9.6. At bronchoscopy, 41.5% lesions were identified as focal solitary mass, 22% were normal, 17.1% were mucosae asperity or edema, 9.8% were diffuse airway submucosal nodules or thickening and 9.8% were bronchiole stenosis, while certain endobronchial patterns may correspond to specific imaging features. Conclusions: Pulmonary lymphoma sometimes creates significant diagnostic dilemma for the clinicians, while the imaging features and endobronchial patterns are characteristic. Bronchoscopy is still a useful tool, that is minimally invasive, to diagnose pulmonary lymphoma, while accurate analysis of the clinico-radiological records is essential before such procedure.