Concidence of lung cancer and chronic lymphoproliferation among patients of Hematology Department in Lublin
Bożena Sokołowska, Anna Dmoszyńska, Danuta Skomra, Daniel Chibowski, Jarosław Swatek, Damian Domański
CaseRepClinPractRev 2001; 2(1):17-23
As it follows from literature data, secondary neoplasia develops in ca 10% of patients with hematologic proliferative disorders. It is commonly regarded as a result of long-term chemotherapy, and of alkylating agents in particular. However, it may also develop at the early stages of the disease which do not require chemotherapy yet. Pulmonary lesions observed at this stage of the disease are inappropriately treated as the consequence of the underlying condition, which causes a delay of proper diagnosis and reduces the chances of successful treatment. The paper presents the cases of six patients with lymphoproliferative diseases who developed lung cancer. The first case was a 70-year old man in whom the diagnosis of stage II pbl-B according to Rai's classification coincided with that of pulmonary lesions regarded as due to the disease or of specific origin. The attempts to collect material allowing to determine precisely the nature of the lesions by thin needle biopsy or bronchoscopy failed, and only two years after the diagnosis of pbl-B gigantocellular carcinoma of the lungs was diagnosed. The second patient, a man aged 49, was treated from April 1998 for stage IV pbl-B according to Rai. By May 1999 he had undergone 5 courses of treatment with 2Cd-A with Encorton, which resulted in an increase of thrombocytopenia. In the middle of August 1999, his condition was complicated by a sudden severe pain in the right portion of the chest, aggravating on respiration, dry cough, dyspnea and fever. Because of the lack of effect of instituted treatment, bronchoscopy was performed. The biopsy collected from cauliflower-like lesions found in the opening of the bronchus entering the superior pulmonary lobe revealed cornifying epithelial squamous cell carcinoma. The third patient, a 63-year-old man, had had stage II pbl-B diagnosed four years earlier. Because of his stable condition, no chemotherapy was needed. In June 1999, the patient started to complain of aggravating pains in the chest, persistent cough and fever. During the following two months he was hospitalized several times in the lung diseases and TB ward. The patient's condition worsened, the pain became more and more severe and progressive cachexia was observed due to problems with swallowing. The biopsy collected from infiltrations located in the left side of the chest revealed the texture of gigantocellular carcinoma of the lung. In the fourth case of a 56-year-old man stage pbl-B according to Rai was diagnosed in 1998. Because of the early stage of the disease, the patient was observed on an outpatient basis. Chest X-rays were performed systematically because of long-term history of smoking and chronic obstructive lung disease diagnosed in 1994. Two years after the diagnosis of pbl-B, control chest X-ray revealed a nodule in the left lung. After confirmation of the finding by CT, the patient was qualified for surgery. Carcinoma acrocellulare was diagnosed by intra- and post-operative histopathology. In the fifth patient, a 45-year-old-an, stage IV lymphocytoma was diagnosed. After three-year chemotherapy, combined with abdominal radiotherapy, the patient developed pulmonary adenocarcinoma in parallel with the progression of the underlying disease. Both neoplasias were very advanced, with infiltrations of numerous organs and bone marrow, which resulted in the patient's death. The observed infiltrations of the lungs were regarded as related to the primary disease. The diagnosis of cancer was established on autopsy. The last patient, a 67-year-old man, received from 1986 to 1996 multidrug therapy for non-Hodgkin lymphoma of intermediate degree of malignancy. In 1996 he was admitted to the Clinic because of blood presence in sputum. The diagnosis of squamous epithelial cell carcinoma of the lung was established on the basis of histopathology of sputum samples. It seems, on the basis of literature data, as well as own observations, that the patients with pbl-B are predisposed for secondary neoplasia both because of the lymphoproliferative process itself and of accompanying genetic changes, as well as incorrect immune response due to a defect of B- lymphocytes.
Keywords: chronic lymphoproliferative disease, lung cancer