Pnömokonyoza Eşlik Eden Lenfoma Olgusu

Yıl 2023, , 136 - 138, 30.09.2023

Serhat Özgün , Gülden Sarı , Adem Koyuncu , Fatma Tanrıkulu Benli , Cebrail Şimşek

https://doi.org/10.20492/aeahtd.1270471

Öz

Non-Hodgkin Lenfoma (NHL), en sık görülen hematolojik malignite olup Diffüz Büyük B Hücreli Lenfoma (DBBHL) en sık görülen histolojik tipidir. 56 yaşında erkek hasta kliniğimize 1 aydır devam eden nefes darlığı ve halsizlik şikayetleri ile başvurdu. Meslek öyküsünde 30 yıldır diş teknisyenliği yaptığı öğrenildi. 2020 yılında pnömokonyoz tanısı mevcuttu ve pnömokonyoz radyografilerinin International Labour Organization (ILO) Uluslararası Sınıflandırması’na göre akciğer radyografisi q/t 3/3 idi. Laboratuar incelemelerinde eritrosit sedimantasyon hızında (ESR 50 mm/h) ve serum laktat dehidrojenaz (LDH 368 IU/L) düzeylerinde yükselme saptandı. Çekilen torakal bilgisayarlı tomografide (BT)’de mediastinal, subkarinal ve bilateral hiler alanlarda yer yer konglomerasyon gösteren ve yer yer kalsifikasyonlar içeren büyümüş lenf nodları ve lenfadenopatiler (LAP) görüldü. Sağ orta zonda daha belirgin olmak üzere her iki akciğerde hilustan parankime uzanan, internal kalsifikasyonlar içeren, geniş yayılımlı inhomojen kitlesel vasıfta konsolidasyon alanları izlendi. Her iki akciğerde yaygın interstisyel kalınlaşmalar, infiltrasyonlar ve sentrilobüler nodüler dansite artışları, özellikle sol üst zonda daha belirgin olmak üzere çekintili konturlu nodüler konsolide alanlar ve nodüller ile buzlu cam dansiteleri izlendi. Sol 5. kot lateral kesiminde yaklaşık 12x5 cm boyutunda, kortikal destrüksiyona neden olan, çevre yumuşak dokular ve kas planlarını invaze eden, internal kistik-nekrotik komponentler içeren heterojen yumuşak doku kitlesi izlendi. Abdomen BT’de abdomende bir kısmı kalsifikasyonlar içeren büyümüş lenf nodları ve LAP’lar izlendi. PMF için tipik olmayan radyografik görünümler nedeniyle transtorasik biyopsi yapılan hastada patoloji sonucu Diffüz B Hücreli Lenfoma olarak raporlandı. Burada mesleki karsinojen maruziyeti olan ve lenfoma ile prezente olan pnömokonyoz tanılı olguyu sunduk.

Anahtar Kelimeler

pnömokonyoz, lenfoma, meslek

Lymphoma Accompanyıng Pneumoconıosıs; Case Report

Öz

Non-Hodgkin Lymphoma (NHL) is the most common hematological malignancy, and Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histological type. A 56-year-old male patient was admitted to our clinic with complaints of shortness of breath and fatigue for 1 month. It was learned in his professional history that he had been a dental technician for 30 years. He was diagnosed with pneumoconiosis in 2020 and his chest radiograph was q/t 3/3 according to the International Labor Organization (ILO) International Classification of pneumoconiosis radiographs. Laboratory examinations revealed an increase in erythrocyte sedimentation rate (ESR 50 mm/h) and serum lactate dehydrogenase (LDH 368 IU/L) levels. On thoracic computed tomography (CT), enlarged lymph nodes and lymphadenopathies (LAP) with local conglomeration and calcifications in the mediastinal, subcarinal and bilateral hilar areas were seen. Widely disseminated inhomogeneous mass-like consolidation areas, including internal calcifications, extending from the hilum to the parenchyma in both lungs, were observed more prominently in the right middle zone. Diffuse interstitial thickenings, infiltrations and centrilobular nodular density increases in both lungs, nodular consolidated areas with recessed contours and nodules and ground glass densities were observed, especially in the left upper zone. In the lateral part of the left 5th rib, a heterogeneous soft tissue mass of approximately 12x5 cm, causing cortical destruction, invading the surrounding soft tissues and muscle planes, and containing internal cystic-necrotic components was observed. On abdominal CT, enlarged lymph nodes and LAPs, some of which contain calcifications, were observed in the abdomen. The pathology result was reported as Diffuse B-Cell Lymphoma in the patient who underwent transthoracic biopsy due to radiographic appearances that are not typical for PMF. Here, we presented a case of pneumoconiosis with occupational carcinogen exposure and presenting with lymphoma.

Anahtar Kelimeler

pneumoconiosis, lymphoma, occupation

Kaynakça

• 1. LaDou, J., & Harrison, R. Current occupational & environmental medicine. New York: McGraw-Hill. 2021;392
• 2. IARC. Agents Classified by the IARC Monographs. 2019;1-127. Accessed 2020 July 06. http://monographs.iarc.fr/ENG/Classification/index.php
• 3. Uskudar Teke H, Yaman F, Andic N, et al. Evaluation of Subcutaneous Rituximab Treatment Results in Patients with B-Cell Non-Hodgkin Lymphoma: A Single Center Experience, Osmangazi Journal of Medicine, 2022;44(5): 601-604 doi: 10.20515/otd.1074211
• 4. Shenoy PJ, Malik N, Nooka A, et al. Racial differences in the presentation and outcomes of diffuse large B-cell lymphoma in the United States. Cancer. 2011;117(11):2530-2540. doi:10.1002/cncr.257655
• 5. Kim TS, Kim HA, Heo Y, Park Y, Park CY, Roh YM. Level of silica in the respirable dust inhaled by dental technicians with demonstration of respirable symptoms. Ind Health. 2002;40(3):260-265. doi:10.2486/indhealth.40.260
• 6. Hu SW, Lin YY, Wu TC, Hong CC, Chan CC, Lung SC. Workplace air quality and lung function among dental laboratory technicians. Am J Ind Med. 2006;49(2):85-92. doi:10.1002/ajim.20249
• 7. Ogata R, Soda H, Tanaka Y, et al. Onset of pulmonary Epstein-Barr virus-positive diffuse large B-cell lymphoma in a patient with silicosis. Thorac Cancer. 2022;13(1):133-136. doi:10.1111/1759-7714.14250
• 8. Ogihara Y, Ashizawa K, Hayashi H, et al. Progressive massive fibrosis in patients with pneumoconiosis: utility of MRI in differentiating from lung cancer. Acta Radiol. 2018;59(1):72-80. doi:10.1177/0284185117700929
• 9. ILO. (2011). Guidelines for the use of the ILO International Classification of Radiographs of Pneumoconioses (revised edition 2011). Geneva: ILO.
• 10. Yu H, Zhang H, Wang Y, Cui X, Han J. Detection of lung cancer in patients with pneumoconiosis by fluorodeoxyglucose-positron emission tomography/computed tomography: four cases. Clin Imaging. 2013;37(4):769-771. doi:10.1016/j.clinimag.2012.11.001
• 11. Arakawa H, Shida H, Saito Y, et al. Pulmonary malignancy in silicosis: factors associated with radiographic detection. Eur J Radiol. 2009;69(1):80-86. doi:10.1016/j.ejrad.2007.08.035
• 12. Sarı G, Gökçek A, Koyuncu A, Şimşek C. Computed Tomography Findings in Progressive Massive Fibrosis: Analyses of 90 Cases. Med Lav. 2022;113(1):e2022002. Published 2022 Feb 22. doi:10.23749/mdl.v113i1.12303