Pulmonary manifestations in patients with cutaneous T-cell lymphomas

BACKGROUND. Lungs are among the most common organs of extranodal involvement by cutaneous T-cell lymphomas (CTCLs), yet the magnitude of lung involvement is not clear, and only a few case reports have addressed this issue to date. The objective of this study was to present the authors' observations on how to recognize lung involvement by CTCL and evaluate the clinical and radiologic differences between involvement of the lungs by CTCL and by pneumonia. METHODS. A retrospective analysis was conducted of all 710 patients with confirmed CTCL who presented to The University of Texas M. D. Anderson Cancer Center between January 1996 and January 2005. Demographics, tumor characteristics, respiratory symptoms, thoracic imaging, microbiology, and laboratory studies were reviewed. RESULTS. During the 9-year period that was studied, 122 patients presented with pulmonary radiologic abnormalities, including 67 patients who also had respiratory symptoms. Pneumonia (n = 27 patients) or lung involvement (n = 6 patients) in patients with CTCL were associated with high mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.08-3.07%; P = .026). The pathogens that were isolated from lower respiratory cultures were Staphylococcus aureus (n = 4 patients), Aspergillus fumigatus (n = 2 patients), Mycobacterium avium-intracellulare (n = 2 patients), Pseudomonas aeruginosa (n = 1 patient), respiratory syncytial virus (n = 1 patient), and Candida parapsilosis (n = 1 patient). Most of the radiologic findings in patients with pneumonia were opacities. Six patients had involvement of lung by CTCL, and most common radiologic pulmonary findings were either a solitary nodule or multiple progressing pulmonary nodules. CONCLUSIONS. Pneumonia and lung involvement by CTCL are relatively rare but portend poor survival. Thus, patients with CTCL should be evaluated thoroughly with thoracic imaging when they experience respiratory symptoms.