Sputum cytology in the diagnosis of pulmonary non-Hodgkin's lymphoma.

Australia Pulmonary disease in non-Hodgkin's lymphoma is known to occur in 10-25% of patients,' 2 but the exact diagnosis during life remains difficult and usually depends on exclusion of other possibilities-for example, infection and haemorrhage-or the use of techniques such as fibreoptic bronchoscopy, bronchial brushing, and needle biopsy.3 Cytological examination of the sputum, which is a much simpler and a non-invasive investigation of proved efficacy in patients with bronchogenic carcinoma, is seldom used in patients with suspected intrathoracic non-Hodgkin's lym-phoma. In this report we describe two patients with non-Hodgkin's lymphoma with pulmonary involvement in whom the sputum was positive for lymphoma cells. A 64 year old woman first presented to the clinical haematology unit in January 1982 after the diagnosis of non-Hodgkin's lymphoma. She was known to have had Sjogren's syndrome since 1970, with several exacerbations of arthritis during the next 10 years. A routine chest radio-graph performed in May 1981 showed multiple round opacities, but percutaneous fine needle aspiration of the most posterior lesion failed to establish its nature. She remained well until December 1981, when she presented with episodic lower abdominal pain and was found to have a pelvic mass. At laparotomy a benign ovarian cyst was found. The surgeon also noted the presence of several pale and rubbery lesions in the transverse colon and ileocaecal junction as well as the jejunum. Right hemicolectomy was performed and histological examination showed non-Hodgkin's lymphoma of the large cleaved cell type with a diffuse pattern. A chest radiograph now showed increase in size of the lung lesion in the right lower and left upper zones; cytological examination of the sputum showed lym-phoma cells (fig 1). After further staging investigations she was assessed as having stage IIIB disease4; combination chemotherapy with ATEP (adriamycin, teniposide, cyclo-phosphamide, and prednisone) was given with good results. The lung lesions resolved and she remained in complete remission receiving four to six weekly chemotherapy until March 1983, when pulmonary lesions returned together with a right sided pleural effusion. She was also noted to have right sided third cranial nerve palsy. Sputum, pleural fluid, and cerebrospinal fluid all showed lymphoma cells on cytological examination. The disease proved to be resistant to further treatment, including radiotherapy, and she died in May 1983. Necropsy was not performed. A 62 year old woman first presented in May 1981 with abdominal pain and was noted to have a large epigastric mass. At laparotomy …