1/8. bronchiolitis obliterans organizing pneumonia after tangential beam irradiation to the breast: discrimination from radiation pneumonitis.We report a case of bronchiolitis obliterans organizing pneumonia (BOOP) secondary to tangential beam irradiation to the breast, which occurred seven months after the completion of radiotherapy. Although radiation pneumonitis is an alternative consideration, BOOP could be differentiated from it by its relatively late onset and extensive distribution, which did not respect the radiation field. This disease should always be kept in mind in patients with a history of tangential beam irradiation to the breast.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
2/8. Squamous cell carcinoma of the lung producing granulocyte colony-stimulating factor and resembling a malignant pleural mesothelioma.A 65-year-old was admitted to our hospital and was diagnosed as having squamous cell carcinoma originating in the right upper bronchus. He underwent both chemotherapy and radiation therapy, but these therapies were ineffective and thereafter the developed radiation pneumonitis and carcinomatous pleuritis. Finally, he died of bacterial pneumonia in the opposite normal lung of four months duration. From one month before his death, laboratory data indicated marked leukocytosis, and his granulocyte colony-stimulating factor (G-CSF) serum level was high. At autopsy, squamous cell carcinoma was found in the right hilus region of the lung, with a spreading form resembling a malignant pleural mesothelioma mainly occupying the pleural cavity. Based on positive staining method with specific monoclonal antibodies against G-CSF, it was considered that the leukocytosis was caused by G-CSF producing tumor.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
3/8. A case of bronchiolitis obliterans organizing pneumonia syndrome with preceding radiation pneumonitis after breast-conserving therapy.Recent case series have demonstrated that bronchiolitis obliterans organizing pneumonia (BOOP) after radiation therapy to the breast is a distinct clinicopathological entity. Most of the investigators speculated that radiation may prime the development of BOOP through an unidentified immunological process; however, none of them showed the relationship between direct radiation injury and BOOP. We report herein a case of a 67-year-old female with BOOP following direct radiation damage confined to the irradiated area after breast-conserving therapy. This is the first case demonstrating that BOOP after breast-conserving therapy arises from direct radiation injury.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
4/8. cryptogenic organizing pneumonia after radiotherapy for breast cancer.We report a case of lasting fever and cough with pulmonary infiltrates progressing 4 months after adjuvant radiotherapy following surgery for breast cancer. Chest radiography and computed tomography demonstrated alveolar opacities outside the irradiated pulmonary area. Laboratory data revealed neutrophilia and increased levels of c-reactive protein. bronchoalveolar lavage fluid displayed increased lymphocyte counts, and transbronchial lung biopsy revealed histological patterns compatible with cryptogenic organizing pneumonia (COP). Corticosteroid therapy resulted in marked clinical improvement. From the histological and clinical findings, this case was judged to be a case of COP induced after radiotherapy for breast cancer, similar to those reported recently.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
5/8. Migratory bronchiolitis obliterans organizing pneumonia after unilateral radiation therapy for breast carcinoma.We report the case of a 59 year old woman who developed cough, dyspnoea and fever with patchy migratory airspace infiltrates, 2 months after right breast radiation therapy for breast carcinoma. Lung infiltrates were initially localized in the irradiated area and spread to the contralateral lung. Lung biopsy, performed in an unirradiated area of the contralateral lung 9 months after completion of radiotherapy, revealed a typical histological pattern of bronchiolitis obliterans organizing pneumonia. No cause of bronchiolitis obliterans organizing pneumonia other than radiation was found. Treatment with corticosteroids resulted in rapid clinical improvement and complete resolution of airspace opacities. This case suggests that localized lung irradiation might trigger the development of a bilateral lung disease, with a histological pattern of bronchiolitis obliterans organizing pneumonia.- - - - - - - - - - ranking = 1.4keywords = pneumonia (Clic here for more details about this article) |
6/8. Migratory organizing pneumonitis "primed" by radiation therapy.We report on two women presenting with cough and fever, 4 and 7 months, respectively, after starting breast radiation therapy following surgery for breast carcinoma. Chest roentgenogram and computed tomographic (CT) scan demonstrated alveolar opacities, initially limited to the pulmonary area next to the irradiated breast, but later migrating within both lungs. Intra-alveolar granulation tissue was found in transbronchial lung biopsies. Corticosteroid treatment resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. However, clinical and imaging relapses occurred when corticosteroids were withdrawn too rapidly; with further improvement when they were reintroduced. The reported cases clearly differ from radiation pneumonitis. They were fairly typical of cryptogenic organizing pneumonitis, also called idiopathic bronchiolitis obliterans organizing pneumonia, with the exception of the radiation therapy, partially affecting the lung, which had been performed within the previous months. Since focal radiation therapy involving the lung may induce diffuse bilateral lymphocytic alveolitis, we hypothesize that this may "prime" the lung to further injury, leading to cryptogenic organizing pneumonitis.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
7/8. Chronic lymphocytic alveolitis with migrating pulmonary infiltrates after localized chest wall irradiation.In a number of patients, radiotherapy following surgery for breast carcinoma may induce radiation injury to the lungs. This has classically been divided into an early radiation pneumonitis and a late fibrosis, both confined to the irradiated lung volume. However we observed a female patient who similarly to other recent reports in the literature developed a recurring pneumonitis migrating from one lung to the other after radiotherapy for breast carcinoma. This migratory BOOP (bronchiolitis obliterans organizing pneumonia) was characterized by a lymphocytic alveolitis and responded well to corticosteroids. Clinicians should be aware of the possibility of a lymphocytic pneumonitis in both lungs after unilateral thoracic irradiation and recognize the distinctive features of fever, cough, dyspnoea and malaise in order to start an effective treatment with corticosteroids. They should also be aware of the high tendency for recurrence when tapering off.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
8/8. Corticosteroids and azathioprine do not prevent radiation-induced lung injury.The case of a man who presented with dyspnea and a dry cough six weeks after mediastinal radiotherapy for malignant thymoma is described. The patient was on prednisone (30 mg/day) and azathioprine (100 mg/day) throughout the course of radiation. The respiratory difficulties developed as the dose of prednisone was gradually decreased to 20 mg/day postradiation. Chest x-ray showed bilateral pulmonary infiltrates. Computed tomography scan of the thorax confirmed bilateral ground glass opacities, with well-defined lateral margin on the right side corresponding to the field of radiation. However, the airspace opacities extended beyond the radiation field into the periphery of the lungs together with mild airway dilation on the left side compatible with bronchiolitis obliterans organizing pneumonia (BOOP) or cryptogenic organizing pneumonia. Bronchoalveolar lavage performed on the nonirradiated area showed an intense lymphocytosis. No cause of BOOP other than radiation was found. Treatment with high dose corticosteroids (80 mg/day) resulted in rapid clinical and radiological improvement, and resolution of chest x-ray abnormalities. Focal mediastinal radiation therapy may induce diffuse lung injury including BOOP. In addition, the concurrent use of moderate dose prednisone and azathioprine during the periradiotherapy period does not prevent the development of either BOOP or classic radiation pneumonitis.- - - - - - - - - - ranking = 0.4keywords = pneumonia (Clic here for more details about this article) |