Pulmonary nodular lesions in bone marrow transplant recipients: impact of histologic diagnosis on patient management and prognosis.
Bone marrow transplantation is associated with numerous pulmonary complications, which may manifest as nodules. We studied 33 bone marrow transplant (BMT) recipients in whom pulmonary nodular lesions (PNLs) developed during a 5-year period and who underwent open lung biopsy (OLB) for diagnosis. Of 33 patients with PNL, 15 (45%) had pulmonary cytolytic thrombi (PCT), a recently described condition characterized histologically by occlusive vascular lesions and hemorrhagic infarcts and clinically by a favorable outcome. Clinical symptoms and radiologic abnormalities disappeared during a period of a few weeks. None of the patients died of PCT; 10 were alive at last contact. The second most common cause of PNL (8/33 [24%]) was Aspergillus infection, which was the cause of death in 6. OLB is an effective way of obtaining diagnostic tissue in BMT recipients with PNLs. Histologic examination is accurate in determining the cause of PNLs and identifying lesions that have a favorable outcome and those that require a change in treatment.
Department of Laboratory Medicine and Pathology, University of Minnesota, Fairview University Medical Center, Minneapolis 55455, USA.
H Evin
HE
Gulbahce
Stefan E
SE
Pambuccian
Jose
J
Jessurun
Paul
P
Woodard
Marie E
ME
Steiner
J Carlos
JC
Manivel
Stephen
S
Hite
Norma K C
NK
Ramsay
K Scott
KS
Baker
D000293:Adolescent; D000328:Adult; D001228:Aspergillosis / Q000150:complications / Q000473:pathology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008172:Lung Diseases, Fungal / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications / Q000473:pathology*; D003074:Solitary Pulmonary Nodule / Q000209:etiology / Q000473:pathology* / Q000628:therapy