title: Pulmonary Intravascular Lymphomatosis: Clinical, CT, and PET Findings, Correlation of CT and Pathologic Results, and Survival Outcome.
abstract: Purpose To describe clinical, computed tomographic (CT), and positron emission tomographic (PET) features, correlation of CT and pathologic results, and survival of patients with pulmonary intravascular lymphomatosis. Materials and Methods The institutional review board approved this retrospective study with waiver of patient consent. Forty-two patients with pulmonary intravascular lymphomatosis were identified, 11 (26%) of whom showed lung involvement. CT features were correlated with histopathologic results. Clinical and survival outcomes were compared between patients with and those without pulmonary involvement by adopting the χ(2), Student t, or Kaplan-Meier analysis with log-rank tests. Results At clinical presentation, all 11 patients showed B symptoms (systemic symptoms of fever, night sweats, and weight loss), 10 had respiratory and four had neurologic symptoms, and two had skin lesions. Patients received cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with (n = 5) or without (n = 6) rituximab, and seven (64%) patients died. Patients with lung involvement showed reduced overall and recurrence-free survival (median; 10.8 and 18.9 months, respectively) compared with those without lung involvement (median, 18.4 and 31.0 months, respectively) (P = .338 and .065, respectively). The most common CT abnormality was bilateral ground-glass opacity (GGO, n = 10), with increased fluorodeoxyglucose uptake at PET/CT (seven of seven patients). GGO correlated histopathologically with the expanded alveolar septal vasculatures and perivascular spaces filled with neoplastic lymphoid cells. Conclusion Pulmonary intravascular lymphomatosis appeared as bilateral GGO on CT images, with increased fluorodeoxyglucose uptake on PET/CT images. GGO on CT images correlated with the area of expanded alveolar septae because of distended vessels filled with neoplastic lymphoid cells. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Cha
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Hwang
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Tae Jung
authors.initials: TJ
authors.lastname: Kim
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Kim
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Byung-Tae
authors.initials: BT
authors.lastname: Kim
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Young-Hyeh
authors.initials: YH
authors.lastname: Ko
authors.affiliation: From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008202:Lymphangioma / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed