wikidoc - User contributions [en]

Bronchopneumonia

2019-02-01T18:35:29Z

Sindhuja palle: /* Imaging Findings */

__NOTOC__
{{SI}}
{{CMG}}

== Historical Perspective ==
* [[Pneumonia]] was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and [[Lobar Pneumonia]].

== Classification ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with [[acute bronchiolitis]] is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with [[Neutrophil|neutrophils]] and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma.
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.
* Bronchopneumonia is usually associated with infections due to [[gram-negative bacteria]], ''[[Staphylococcus aureus]]'' and some fungi.

== Clinical Features ==
* Common clinical findings in Bronchopneumonia include [[cough]], [[fever]], [[chills]], [[dyspnea]], [[pleuritic chest pain]] and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating Bronchopneumonia from other Diseases ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: [[Hypersensitivity pneumonitis]], [[Connective tissue disease|Collagen vascular disease]], [[Asbestosis]], Drug toxicities, [[Idiopathic pulmonary fibrosis|Pulmonary fibrosis]], [[Pulmonary edema]], [[Pulmonary embolism]] and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors ==
* Common risk factors in the development of Bronchopneumonia are [[Influenza]] infection, Alcohol abuse, [[Hyposplenism/splenectomy]], smoking, [[Chronic obstructive pulmonary disease|COPD]]/[[Asthma]] and [[Immunodeficiency|Immunocompromise]]. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a [[nosocomial infection.]]

== Natural History, Complications and Prognosis ==
* Early clinical features include sudden [[fever]], chills, [[cough]] and [[chest pain]].<ref name="Mackenzie20165" />
* If left untreated, patients with Bronchopneumonia may progress to develop [[tachypnea]] and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include [[parapneumonic effusion]], [[empyema]], [[necrotizing pneumonia]], [[lung abscess]] and metastatic infections such as [[endocarditis]], [[septic arthritis]], [[peritonitis]], [[pericarditis]] and [[meningitis]], and other cardiac complications.

== Diagnosis ==

=== Diagnostic Study of choice ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms ===
*Symptoms of Bronchopneumonia may include the following:
** [[Fever]]
** Chills
** [[Cough]]
** [[Chest pain|Chest Pain]]
** [[Dyspnea|Shortness of breath]]
=== Physical Examination ===
* Physical examination may be remarkable for:
** [[Fever]]
** Respiratory rate >24 breaths/min ([[Tachypnea]])
** [[Tachycardia]]
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** [[Tactile fremitus]]
*** [[Egophony]]
=== Laboratory Findings ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A [[leukocytosis]] (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of [[Erythrocyte sedimentation rate|ESR]] or [[C-reactive protein|CRP]] is a non-specific indication of inflammation in the body.

=== Imaging Findings ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by peribronchial thickening and poorly defined air-space opacities. Inhomogeneous patchy areas of consolidation involving several lobes reflect more severe disease. When confluent, bronchopneumonia may resemble lobar pneumonia.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
[[File:Bronchopneumonia.jpg|center|thumb|Bronchopneumonia Case courtesy of Dr Henry Knipe, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/49869">rID: 49869</a>]]
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, [[Polymerase chain reaction|PCR]] and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment ==

=== Medical Therapy ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities [[Macrolide|Macrolides]] such as [[Azithromycin]] and [[Clarithromycin]] can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, [[Doxycycline]], [[Amoxicillin-Clavulanate]], and [[Cephalosporin|Cephalosporins]] such as [[Cefpodoxime]] and [[Cefuroxime]] may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}
<references />

File:Bronchopneumonia.jpg

2019-02-01T18:29:30Z

Sindhuja palle:

Bronchopneumonia

2019-02-01T17:32:51Z

Sindhuja palle: /* Imaging Findings */

__NOTOC__
{{SI}}
{{CMG}}

== Historical Perspective ==
* [[Pneumonia]] was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and [[Lobar Pneumonia]].

== Classification ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with [[acute bronchiolitis]] is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with [[Neutrophil|neutrophils]] and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma.
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.
* Bronchopneumonia is usually associated with infections due to [[gram-negative bacteria]], ''[[Staphylococcus aureus]]'' and some fungi.

== Clinical Features ==
* Common clinical findings in Bronchopneumonia include [[cough]], [[fever]], [[chills]], [[dyspnea]], [[pleuritic chest pain]] and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating Bronchopneumonia from other Diseases ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: [[Hypersensitivity pneumonitis]], [[Connective tissue disease|Collagen vascular disease]], [[Asbestosis]], Drug toxicities, [[Idiopathic pulmonary fibrosis|Pulmonary fibrosis]], [[Pulmonary edema]], [[Pulmonary embolism]] and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors ==
* Common risk factors in the development of Bronchopneumonia are [[Influenza]] infection, Alcohol abuse, [[Hyposplenism/splenectomy]], smoking, [[Chronic obstructive pulmonary disease|COPD]]/[[Asthma]] and [[Immunodeficiency|Immunocompromise]]. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a [[nosocomial infection.]]

== Natural History, Complications and Prognosis ==
* Early clinical features include sudden [[fever]], chills, [[cough]] and [[chest pain]].<ref name="Mackenzie20165" />
* If left untreated, patients with Bronchopneumonia may progress to develop [[tachypnea]] and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include [[parapneumonic effusion]], [[empyema]], [[necrotizing pneumonia]], [[lung abscess]] and metastatic infections such as [[endocarditis]], [[septic arthritis]], [[peritonitis]], [[pericarditis]] and [[meningitis]], and other cardiac complications.

== Diagnosis ==

=== Diagnostic Study of choice ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms ===
*Symptoms of Bronchopneumonia may include the following:
** [[Fever]]
** Chills
** [[Cough]]
** [[Chest pain|Chest Pain]]
** [[Dyspnea|Shortness of breath]]
=== Physical Examination ===
* Physical examination may be remarkable for:
** [[Fever]]
** Respiratory rate >24 breaths/min ([[Tachypnea]])
** [[Tachycardia]]
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** [[Tactile fremitus]]
*** [[Egophony]]
=== Laboratory Findings ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A [[leukocytosis]] (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of [[Erythrocyte sedimentation rate|ESR]] or [[C-reactive protein|CRP]] is a non-specific indication of inflammation in the body.

=== Imaging Findings ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by peribronchial thickening and poorly defined air-space opacities. Inhomogeneous patchy areas of consolidation involving several lobes reflect more severe disease. When confluent, bronchopneumonia may resemble lobar pneumonia.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
[[File:Bronchopneumonia caused by aspergillus.jpg|center|thumb|Posteroanterior chest radiograph reveals bilateral nonsegmental consolidations in the lingula and in the right upper and lower lobes. ''[[Aspergillus fumigatus]]'' was recovered from the sputum.

Taken from: https://erj.ersjournals.com/content/18/1/196 ]]

* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, [[Polymerase chain reaction|PCR]] and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment ==

=== Medical Therapy ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities [[Macrolide|Macrolides]] such as [[Azithromycin]] and [[Clarithromycin]] can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, [[Doxycycline]], [[Amoxicillin-Clavulanate]], and [[Cephalosporin|Cephalosporins]] such as [[Cefpodoxime]] and [[Cefuroxime]] may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}
<references />

Bronchopneumonia

2019-01-24T22:05:16Z

Sindhuja palle: /* Overview */

__NOTOC__
{{SI}}
{{CMG}}

== Historical Perspective ==
* [[Pneumonia]] was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and [[Lobar Pneumonia]].

== Classification ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with [[acute bronchiolitis]] is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with [[Neutrophil|neutrophils]] and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma.
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.
* Bronchopneumonia is usually associated with infections due to [[gram-negative bacteria]], ''[[Staphylococcus aureus]]'' and some fungi.

== Clinical Features ==
* Common clinical findings in Bronchopneumonia include [[cough]], [[fever]], [[chills]], [[dyspnea]], [[pleuritic chest pain]] and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating Bronchopneumonia from other Diseases ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: [[Hypersensitivity pneumonitis]], [[Connective tissue disease|Collagen vascular disease]], [[Asbestosis]], Drug toxicities, [[Idiopathic pulmonary fibrosis|Pulmonary fibrosis]], [[Pulmonary edema]], [[Pulmonary embolism]] and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors ==
* Common risk factors in the development of Bronchopneumonia are [[Influenza]] infection, Alcohol abuse, [[Hyposplenism/splenectomy]], smoking, [[Chronic obstructive pulmonary disease|COPD]]/[[Asthma]] and [[Immunodeficiency|Immunocompromise]]. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a [[nosocomial infection.]]

== Natural History, Complications and Prognosis ==
* Early clinical features include sudden [[fever]], chills, [[cough]] and [[chest pain]].<ref name="Mackenzie20165" />
* If left untreated, patients with Bronchopneumonia may progress to develop [[tachypnea]] and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include [[parapneumonic effusion]], [[empyema]], [[necrotizing pneumonia]], [[lung abscess]] and metastatic infections such as [[endocarditis]], [[septic arthritis]], [[peritonitis]], [[pericarditis]] and [[meningitis]], and other cardiac complications.

== Diagnosis ==

=== Diagnostic Study of choice ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms ===
*Symptoms of Bronchopneumonia may include the following:
** [[Fever]]
** Chills
** [[Cough]]
** [[Chest pain|Chest Pain]]
** [[Dyspnea|Shortness of breath]]
=== Physical Examination ===
* Physical examination may be remarkable for:
** [[Fever]]
** Respiratory rate >24 breaths/min ([[Tachypnea]])
** [[Tachycardia]]
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** [[Tactile fremitus]]
*** [[Egophony]]
=== Laboratory Findings ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A [[leukocytosis]] (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of [[Erythrocyte sedimentation rate|ESR]] or [[C-reactive protein|CRP]] is a non-specific indication of inflammation in the body.

=== Imaging Findings ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by peribronchial thickening and poorly defined air-space opacities. Inhomogeneous patchy areas of consolidation involving several lobes reflect more severe disease. When confluent, bronchopneumonia may resemble lobar pneumonia.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
[[File:Bronchopneumonia caused by aspergillus.jpg|center|thumb|Posteroanterior chest radiograph reveals bilateral nonsegmental consolidations in the lingula and in the right upper and lower lobes. ''[[Aspergillus fumigatus]]'' was recovered from the sputum. ]]

* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, [[Polymerase chain reaction|PCR]] and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment ==

=== Medical Therapy ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities [[Macrolide|Macrolides]] such as [[Azithromycin]] and [[Clarithromycin]] can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, [[Doxycycline]], [[Amoxicillin-Clavulanate]], and [[Cephalosporin|Cephalosporins]] such as [[Cefpodoxime]] and [[Cefuroxime]] may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}
<references />

Bronchopneumonia

2019-01-02T17:48:32Z

Sindhuja palle: /* Historical Perspective[edit | edit source] */

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma.
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.
* Bronchopneumonia is usually associated with infections due to gram-negative bacteria, ''Staphylococcus aureus'' and some fungi.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.<ref name="Mackenzie20165" />
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.<ref name="pmid17278083">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>
* On chest x-ray, Bronchopneumonia is characterized by peribronchial thickening and poorly defined air-space opacities. Inhomogeneous patchy areas of consolidation involving several lobes reflect more severe disease. When confluent, bronchopneumonia may resemble lobar pneumonia.<ref name="pmid172780832">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
*[[File:Bronchopneumonia caused by aspergillus.jpg|thumb|Posteroanterior chest radiograph reveals bilateral nonsegmental consolidations in the lingula and in the right upper and lower lobes. ''Aspergillus fumigatus'' was recovered from the sputum. ]]In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.<ref name="pmid172780833">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}
<references />

Bronchopneumonia

2019-01-02T17:46:16Z

Sindhuja palle:

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.<ref name="Mackenzie2016">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.<ref name="Mackenzie20162">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.<ref name="Mackenzie20163">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma.
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.
* Bronchopneumonia is usually associated with infections due to gram-negative bacteria, ''Staphylococcus aureus'' and some fungi.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients. <ref name="Mackenzie20164">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.<ref name="Mackenzie20165" />
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by peribronchial thickening and poorly defined air-space opacities. Inhomogeneous patchy areas of consolidation involving several lobes reflect more severe disease. When confluent, bronchopneumonia may resemble lobar pneumonia.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
*[[File:Bronchopneumonia caused by aspergillus.jpg|thumb|Posteroanterior chest radiograph reveals bilateral nonsegmental consolidations in the lingula and in the right upper and lower lobes. ''Aspergillus fumigatus'' was recovered from the sputum. ]]In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}
<references />

Bronchopneumonia

2019-01-02T17:39:48Z

Sindhuja palle: /* References[edit | edit source] */

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma.
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.
* Bronchopneumonia is usually associated with infections due to gram-negative bacteria, ''Staphylococcus aureus'' and some fungi.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.<ref name="Mackenzie20165" />
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by peribronchial thickening and poorly defined air-space opacities. Inhomogeneous patchy areas of consolidation involving several lobes reflect more severe disease. When confluent, bronchopneumonia may resemble lobar pneumonia. <ref>{{Cite book|Muller NL, Fraser RS, Coleman NC, Pare PD. Radiologic Diagnosis of Diseases of the Chest. Philadelphia: WB Saunders Co; 2001.=}}</ref>
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
*[[File:Bronchopneumonia caused by aspergillus.jpg|thumb|Posteroanterior chest radiograph reveals bilateral nonsegmental consolidations in the lingula and in the right upper and lower lobes. ''Aspergillus fumigatus'' was recovered from the sputum. <ref>{{Cite web|url=https://erj.ersjournals.com/content/18/1/196|title=Imaging of pneumonia: trends and algorithms|last=Franquet|first=T.|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}
<references />

File:Bronchopneumonia caused by aspergillus.jpg

2019-01-02T17:35:42Z

Sindhuja palle:

Posteroanterior chest radiograph reveals bilateral nonsegmental consolidations in the lingula and in the right upper and lower lobes. Aspergillus fumigatus was recovered from the sputum.

Bronchopneumonia

2019-01-02T16:57:14Z

Sindhuja palle: /* Historical Perspective[edit | edit source] */

{{SI}}

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.<ref name="Mackenzie2016">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.<ref name="Mackenzie20162">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.<ref name="Mackenzie20163">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.<ref name="Mackenzie20164">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:<ref name="WuytsCavazza2014">{{cite journal|last1=Wuyts|first1=W. A.|last2=Cavazza|first2=A.|last3=Rossi|first3=G.|last4=Bonella|first4=F.|last5=Sverzellati|first5=N.|last6=Spagnolo|first6=P.|title=Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic?|journal=European Respiratory Review|volume=23|issue=133|year=2014|pages=308–319|issn=0905-9180|doi=10.1183/09059180.00004914}}</ref>
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year. <ref name="CillonizMartin-Loeches20162">{{cite journal|last1=Cilloniz|first1=Catia|last2=Martin-Loeches|first2=Ignacio|last3=Garcia-Vidal|first3=Carolina|last4=San Jose|first4=Alicia|last5=Torres|first5=Antoni|title=Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns|journal=International Journal of Molecular Sciences|volume=17|issue=12|year=2016|pages=2120|issn=1422-0067|doi=10.3390/ijms17122120}}</ref>

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.<ref name="pmid107068972">{{cite journal |vauthors=Nuorti JP, Butler JC, Farley MM, Harrison LH, McGeer A, Kolczak MS, Breiman RF |title=Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team |journal=N. Engl. J. Med. |volume=342 |issue=10 |pages=681–9 |date=March 2000 |pmid=10706897 |doi=10.1056/NEJM200003093421002 |url=}}</ref>
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:<ref name="Mackenzie20165">{{cite journal|last1=Mackenzie|first1=Grant|title=The definition and classification of pneumonia|journal=Pneumonia|volume=8|issue=1|year=2016|issn=2200-6133|doi=10.1186/s41479-016-0012-z}}</ref>
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for: <ref name="EvertsenBaumgardner2010">{{cite journal|last1=Evertsen|first1=Jennifer|last2=Baumgardner|first2=Dennis J|last3=Regnery|first3=Ann|last4=Banerjee|first4=Indrani|title=Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices|journal=Primary Care Respiratory Journal|volume=19|issue=3|year=2010|pages=237–241|issn=1471-4418|doi=10.4104/pcrj.2010.00024}}</ref>
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.<ref name="CillonizMartin-Loeches2016">{{cite journal|last1=Cilloniz|first1=Catia|last2=Martin-Loeches|first2=Ignacio|last3=Garcia-Vidal|first3=Carolina|last4=San Jose|first4=Alicia|last5=Torres|first5=Antoni|title=Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns|journal=International Journal of Molecular Sciences|volume=17|issue=12|year=2016|pages=2120|issn=1422-0067|doi=10.3390/ijms17122120}}</ref>

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.<ref name="pmid17278083">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.<ref name="pmid172780832">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.<ref name="pmid172780833">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.<ref name="pmid172780834">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years. <ref name="pmid10706897">{{cite journal |vauthors=Nuorti JP, Butler JC, Farley MM, Harrison LH, McGeer A, Kolczak MS, Breiman RF |title=Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team |journal=N. Engl. J. Med. |volume=342 |issue=10 |pages=681–9 |date=March 2000 |pmid=10706897 |doi=10.1056/NEJM200003093421002 |url=}}</ref>

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T15:49:52Z

Sindhuja palle: /* Overview[edit | edit source] */

{{SI}}

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T15:47:36Z

Sindhuja palle: /* Epidemiology and Demographics[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
* '''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons than caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T15:47:04Z

Sindhuja palle: /* Race[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
* '''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is more commonly observed in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia is more commonly observed in Black persons compared to caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T15:46:02Z

Sindhuja palle: /* Age[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
* '''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Brochopneumonia is seen in higher rates in men than women.

=== Race[edit | edit source] ===
* Bronchopneumonia affects Black persons more than Caucasians.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T15:43:29Z

Sindhuja palle: /* Prevention[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
* '''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.
* Common mechanisms in development of pneumonia include, micro-aspiration, hematogenous spread, spread from a contiguous focus and macro-aspiration.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* Lobular pneumonia must be differentiated from other diseases that cause similar clinical symptoms and interstitial infiltrates on chest x-ray such as:
:* Lobar pneumonia
:* Non-infectious lung conditions such as: Hypersensitivity pneumonitis, Collagen vascular disease, Asbestosis, Drug toxicities, Pulmonary fibrosis, Pulmonary edema, Pulmonary embolism and neoplastic lesions.
:* Other types of pneumonias such as: cryptogenic pneumonia.

== Epidemiology and Demographics[edit | edit source] ==
* The rate of Community acquired pneumonia is approximately 5.16-7.06 cases per 1000 individuals per year.

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Bronchopneumonia affects men and women equally.

=== Race[edit | edit source] ===
* There is no racial predilection for Bronchopneumonia.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis, and other cardiac complications.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
** Fever
** Respiratory rate >24 breaths/min (Tachypnea)
** Tachycardia
** Chest Examination:
*** Audible crackles
*** Decreased or bronchial breath sounds
*** Dullness to percussion in areas of consolidation
*** Tactile fremitus
*** Egophony
=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation. Pneumococcal vaccination is indicated in patients over the age of 65 years.

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T15:25:43Z

Sindhuja palle: /* Treatment[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
* '''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:* [Differential dx1]
:* [Differential dx2]
:* [Differential dx3]

== Epidemiology and Demographics[edit | edit source] ==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Bronchopneumonia affects men and women equally.

=== Race[edit | edit source] ===
* There is no racial predilection for Bronchopneumonia.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
:* Fever
:* Respiratory rate >24 breaths/min (Tachypnea)
:* Tachycardia
:* Chest Examination:
:** Audible crackles
:** Decreased or bronchial breath sounds
:** Dullness to percussion in areas of consolidation
:** Tactile fremitus
:** Egophony

=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum analysis, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* Choice of antibiotics is dependent on epidemiology of microbes, resistance and patients' co-morbidities and severity of illness.
* In patients without co-morbidities Macrolides such as Azithromycin and Clarithromycin can be used. In the case of Macrolide resistant pneumonias and patients with multiple co-morbidities, Doxycycline, Amoxicillin-Clavulanate, and Cephalosporins such as Cefpodoxime and Cefuroxime may be used.
* Response to antibiotics can be monitored with clinical improvement, serum inflammatory markers and chest x-ray findings. However, most non-complicated pneumonias are treated out-patient and only require two follow up treatments to clinically determine improvement and resolution of the pneumonia, respectively. Follow-up chest x-rays are only required in male patients over the age of 50 years and smokers.

=== Prevention[edit | edit source] ===
* Effective measures for the primary prevention of Bronchopneumonia include vaccination against influenza and pneumococcal antigens, and smoking cessation .

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T15:08:21Z

Sindhuja palle: /* Overview[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
* '''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:* [Differential dx1]
:* [Differential dx2]
:* [Differential dx3]

== Epidemiology and Demographics[edit | edit source] ==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Bronchopneumonia affects men and women equally.

=== Race[edit | edit source] ===
* There is no racial predilection for Bronchopneumonia.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis is made when clinical and radiological evidence suggests the presence of Bronchopneumonia.
=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
:* Fever
:* Respiratory rate >24 breaths/min (Tachypnea)
:* Tachycardia
:* Chest Examination:
:** Audible crackles
:** Decreased or bronchial breath sounds
:** Dullness to percussion in areas of consolidation
:** Tactile fremitus
:** Egophony

=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
* In the case of a negative chest x-ray and a high clinical suspicion, HRCT scan may be used to confirm the diagnosis as it has a higher sensitivity and accuracy in detecting lesions and anatomical changes.
* In case of emergency where chest x-ray and HRCT cannot be performed, lung ultrasound performed by an experienced physician can yield findings.

=== Other Diagnostic Studies[edit | edit source] ===
* Microbial analysis in Bronchopneumonia can be performed using techniques such as Blood culture, Sputum culture, PCR and Urine antigen detection, however, pathogens are not commonly identified and empiric treatment should be started once the diagnosis is made.

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* [Medical therapy 1] acts by [mechanism of action 1].
* Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery[edit | edit source] ===
* Surgery is the mainstay of therapy for [disease name].
* [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
* [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention[edit | edit source] ===
* There are no primary preventive measures available for [disease name].

* Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

* Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T14:58:29Z

Sindhuja palle: /* Clinical Features[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
* '''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.
It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..
* Bronchopneumonia is most commonly caused by pneumococcal serotypes 3, 7,8,10,18 and 20.

== Clinical Features[edit | edit source] ==
* Common clinical findings in Bronchopneumonia include cough, fever, chills, dyspnea, pleuritic chest pain and sputum production. However, many of these features may be absent in older patients.
* Bronchopneumonia can also case Gastrointestinal symptoms such as nausea, vomiting and diarrhea.
* Older patients may also present with altered mental status.

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:* [Differential dx1]
:* [Differential dx2]
:* [Differential dx3]

== Epidemiology and Demographics[edit | edit source] ==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Bronchopneumonia affects men and women equally.

=== Race[edit | edit source] ===
* There is no racial predilection for Bronchopneumonia.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:* [criterion 1]
:* [criterion 2]
:* [criterion 3]
:* [criterion 4]

=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Physical examination may be remarkable for:
:* Fever
:* Respiratory rate >24 breaths/min (Tachypnea)
:* Tachycardia
:* Chest Examination:
:** Audible crackles
:** Decreased or bronchial breath sounds
:** Dullness to percussion in areas of consolidation
:** Tactile fremitus
:** Egophony

=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with Bronchopneumonia.

* A Leukocytosis (15000-30000 per mm3) with a left ward shift on a blood test can aid in diagnosis of Bronchopneumonia.
* An elevated concentration of ESR or CRP is a non-specific indication of inflammation in the body.

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for Bronchopneumonia.
* On chest x-ray, Bronchopneumonia is characterized by [finding 1], [finding 2], and [finding 3].
* [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies[edit | edit source] ===
* [Disease name] may also be diagnosed using [diagnostic study name].
* Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* [Medical therapy 1] acts by [mechanism of action 1].
* Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery[edit | edit source] ===
* Surgery is the mainstay of therapy for [disease name].
* [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
* [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention[edit | edit source] ===
* There are no primary preventive measures available for [disease name].

* Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

* Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T06:39:05Z

Sindhuja palle: /* Natural History, Complications and Prognosis[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
'''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.

It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..

== Clinical Features[edit | edit source] ==

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:* [Differential dx1]
:* [Differential dx2]
:* [Differential dx3]

== Epidemiology and Demographics[edit | edit source] ==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* Bronchopneumonia is more commonly observed among elderly patients.

=== Gender[edit | edit source] ===
* Bronchopneumonia affects men and women equally.

=== Race[edit | edit source] ===
* There is no racial predilection for Bronchopneumonia.

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of Bronchopneumonia are Influenza infection, Alcohol abuse, Hyposplenism/splenectomy, smoking, COPD/Asthma and Immunocompromise. Additional risk factors include, homelessness, incarceration, pregnancy, crack cocaine use, opioid use and occupational welding.
* Risk factors for a complicated course include, older age, preexisting lung condition, immunodeficiency/AIDS, and acquisition of a nosocomial infection.

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, chills, cough and chest pain.
* If left untreated, patients with Bronchopneumonia may progress to develop tachypnea and increasing systemic toxicity. They may also progress to develop Lobar pneumonia.
* Common complications of Bronchopneumonia include parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess and metastatic infections such as endocarditis, septic arthritis, peritonitis, pericarditis and meningitis.

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:* [criterion 1]
:* [criterion 2]
:* [criterion 3]
:* [criterion 4]

=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Patients with [disease name] usually appear [general appearance].
* Physical examination may be remarkable for:
:* [finding 1]
:* [finding 2]
:* [finding 3]
:* [finding 4]
:* [finding 5]
:* [finding 6]

=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with [disease name].

* A [positive/negative] [test name] is diagnostic of [disease name].
* An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
* Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

=== Imaging Findings[edit | edit source] ===
* Chest x-ray is the imaging modality of choice for [disease name].
* On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
* [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies[edit | edit source] ===
* [Disease name] may also be diagnosed using [diagnostic study name].
* Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* [Medical therapy 1] acts by [mechanism of action 1].
* Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery[edit | edit source] ===
* Surgery is the mainstay of therapy for [disease name].
* [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
* [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention[edit | edit source] ===
* There are no primary preventive measures available for [disease name].

* Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

* Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2019-01-02T06:02:23Z

Sindhuja palle: /* Diagnosis[edit | edit source] */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
'''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.

It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* Pneumonia may be classified according to anatomic distribution of consolidation into two subtypes/groups:
** Lobar
** Lobular (Bronchopneumonia)
== Pathophysiology[edit | edit source] ==
* The pathogenesis of Bronchopneumonia is characterized by inflammation of lung parenchyma.
* On gross pathology, multiple foci of consolidation is a characteristic feature of Bronchopneumonia. They are present bilaterally, most commonly in the basal lobes. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.
* On microscopic histopathological analysis, a focus of inflammatory condensation, centered by a bronchiola with acute bronchiolitis is a characteristic finding in Bronchopneumonia. In addition, alveolar lumens surrounding the bronchia are filled with neutrophils and suppurative exudate("leukocytic alveolitis"), massive congestion is present and inflammatory foci are separated by normal, aerated parenchyma..

== Clinical Features[edit | edit source] ==

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:* [Differential dx1]
:* [Differential dx2]
:* [Differential dx3]

== Epidemiology and Demographics[edit | edit source] ==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

=== Age[edit | edit source] ===
* Patients of all age groups may develop Bronchopneumonia.

* [Disease name] is more commonly observed among patients aged [age range] years old.
* [Disease name] is more commonly observed among [elderly patients/young patients/children].

=== Gender[edit | edit source] ===
* [Disease name] affects men and women equally.

* [Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

=== Race[edit | edit source] ===
* There is no racial predilection for [disease name].

* [Disease name] usually affects individuals of the [race 1] race.
* [Race 2] individuals are less likely to develop [disease name].

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

== Natural History, Complications and Prognosis[edit | edit source] ==
* Early clinical features include sudden fever, [manifestation 2], and [manifestation 3].
* If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
* Common complications of Bronchopneumonia include [complication 1], [complication 2], and [complication 3].
* Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:* [criterion 1]
:* [criterion 2]
:* [criterion 3]
:* [criterion 4]

=== Symptoms[edit | edit source] ===
*Symptoms of Bronchopneumonia may include the following:
** Fever
** Chills
** Cough
** Chest Pain
** Shortness of breath
=== Physical Examination[edit | edit source] ===
* Patients with [disease name] usually appear [general appearance].
* Physical examination may be remarkable for:
:* [finding 1]
:* [finding 2]
:* [finding 3]
:* [finding 4]
:* [finding 5]
:* [finding 6]

=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with [disease name].

* A [positive/negative] [test name] is diagnostic of [disease name].
* An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
* Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

=== Imaging Findings[edit | edit source] ===
* There are no [imaging study] findings associated with [disease name].

* [Imaging study 1] is the imaging modality of choice for [disease name].
* On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
* [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies[edit | edit source] ===
* [Disease name] may also be diagnosed using [diagnostic study name].
* Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* The mainstay of therapy for Bronchopneumonia is antibiotics and supportive care.
* [Medical therapy 1] acts by [mechanism of action 1].
* Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery[edit | edit source] ===
* Surgery is the mainstay of therapy for [disease name].
* [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
* [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention[edit | edit source] ===
* There are no primary preventive measures available for [disease name].

* Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

* Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

== References[edit | edit source] ==

* Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Bronchopneumonia

2018-12-28T23:25:10Z

Sindhuja palle: /* Pathology */

{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|J|18|0|j|09}} |
ICD9 = {{ICD9|485}} |
ICDO = |
OMIM = |
MedlinePlus = |
eMedicineSubj = |
eMedicineTopic = |
MeshID = D001996 |
}}
{{SI}}

== Overview[edit | edit source] ==
'''Bronchopneumonia''' (Lobular pneumonia) - is one of two types of bacterial pneumonia as classified by gross anatomic distribution of consolidation (solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudate. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more [[pulmonary]] lobes.

It should be noted that although these two patterns of pneumonia, lobar and lobular, are the classic anatomic categories of bacterial pneumonia, in clinical practice the types are difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often leads to lobar pneumonia as the infection progresses. The same organism may cause one type of pneumonia in one patient, and another in a different patient. From the clinical standpoint, far more important than distinguishing the anatomical subtype of pneumonia, is identifying its causative agent and accurately assessing the extent of the disease.

== Historical Perspective[edit | edit source] ==
* Pneumonia was first recognized by Hippocrates. It was first identified and described by Laennec in 1819.
* In 1842, Rokitansky differentiated Pneumonia into Bronchopneumonia and Lobar Pneumonia.

== Classification[edit | edit source] ==
* [Disease name] may be classified according to [classification method] into [number] subtypes/groups:
:* [group1]
:* [group2]
:* [group3]
* Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

== Pathophysiology[edit | edit source] ==
* The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
* The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
* On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
* On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

== Clinical Features[edit | edit source] ==

== Differentiating [disease name] from other Diseases[edit | edit source] ==
* [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:* [Differential dx1]
:* [Differential dx2]
:* [Differential dx3]

== Epidemiology and Demographics[edit | edit source] ==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

=== Age[edit | edit source] ===
* Patients of all age groups may develop [disease name].

* [Disease name] is more commonly observed among patients aged [age range] years old.
* [Disease name] is more commonly observed among [elderly patients/young patients/children].

=== Gender[edit | edit source] ===
* [Disease name] affects men and women equally.

* [Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

=== Race[edit | edit source] ===
* There is no racial predilection for [disease name].

* [Disease name] usually affects individuals of the [race 1] race.
* [Race 2] individuals are less likely to develop [disease name].

== Risk Factors[edit | edit source] ==
* Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

== Natural History, Complications and Prognosis[edit | edit source] ==
* The majority of patients with [disease name] remain asymptomatic for [duration/years].
* Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
* If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
* Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
* Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].

== Diagnosis[edit | edit source] ==

=== Diagnostic Criteria[edit | edit source] ===
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:* [criterion 1]
:* [criterion 2]
:* [criterion 3]
:* [criterion 4]

=== Symptoms[edit | edit source] ===
* [Disease name] is usually asymptomatic.
* Symptoms of [disease name] may include the following:
:* [symptom 1]
:* [symptom 2]
:* [symptom 3]
:* [symptom 4]
:* [symptom 5]
:* [symptom 6]

=== Physical Examination[edit | edit source] ===
* Patients with [disease name] usually appear [general appearance].
* Physical examination may be remarkable for:
:* [finding 1]
:* [finding 2]
:* [finding 3]
:* [finding 4]
:* [finding 5]
:* [finding 6]

=== Laboratory Findings[edit | edit source] ===
* There are no specific laboratory findings associated with [disease name].

* A [positive/negative] [test name] is diagnostic of [disease name].
* An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
* Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

=== Imaging Findings[edit | edit source] ===
* There are no [imaging study] findings associated with [disease name].

* [Imaging study 1] is the imaging modality of choice for [disease name].
* On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
* [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

=== Other Diagnostic Studies[edit | edit source] ===
* [Disease name] may also be diagnosed using [diagnostic study name].
* Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

== Treatment[edit | edit source] ==

=== Medical Therapy[edit | edit source] ===
* There is no treatment for [disease name]; the mainstay of therapy is supportive care.

* The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
* [Medical therapy 1] acts by [mechanism of action 1].
* Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

=== Surgery[edit | edit source] ===
* Surgery is the mainstay of therapy for [disease name].
* [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
* [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

=== Prevention[edit | edit source] ===
* There are no primary preventive measures available for [disease name].

* Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

* Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

== References[edit | edit source] ==

== Pathology ==
Macroscopically: Multiple (focus - geometry) foci of consolidation are present in the [[basal lobes]], often [[bilateral]]. These lesions are 2-4 cm in diameter, grey-yellow, dry, often centered by a [[bronchia]], are poorly delimited and have the tendency to confluence, especially in children.

Microscopically: A focus of inflammatory condensation is centered by a bronchiola with acute bronchiolitis (suppurative exudate - pus - in the [[lumen]] and parietal inflammation). Alveolar lumens surrounding the bronchia are filled with neutrophils ("leukocytic alveolitis"). Massive congestion is present. Inflammatory foci are separated by normal, aerated parenchyma. Photos at: [http://www.pathologyatlas.ro/Bronchopneumonia%201.html 1]

===Drug Causes===

* [[Haloperidol]]
* [[Idursulfase]]

== References ==

Abbas, Abul K, Kumar, Vinay and Fausto, Nelson. Robbins and Coltran Pathologic Basis of Disease, 7th ed. Philadelphia: Elsevier Saunders, 2005.

== External links ==
*[http://www.pathologyatlas.ro/Bronchopneumonia%201.html Atlas of Pathology]

{{Respiratory pathology}}

[[Category:Pneumonia]]
[[Category:Pulmonology]]

[[bg:Бронхопневмония]]
[[pt:Broncopneumonia]]

{{WikiDoc Help Menu}}
{{WS}}

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T21:36:10Z

Sindhuja palle: /* Differentiating SPTCL from other Diseases */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classified under Primary cutaneous lymphomas and expresses the TCRαβ phenotype.<ref name="canadiancancer" />

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as: <ref name="pmid191959752">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref>
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="pmid191959752" />

The female to male ratio is 2:1.

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma. <ref name="pmid191959752" />

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules). <ref name="pmid191959752" /><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* Skin nodules may demonstrate regression with [[lipoatrophy]] at the site of the lesion.
* New nodules can appear at different sites over the course of the disease.
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
:* [[Failure to thrive]]
:* [[Maculopapular rash]]
:* CNS symptoms
:* [[Lymphadenopathy]]
:* [[Coagulopathy]]
:* Abnormal [[Liver function tests|LFT]]<nowiki/>s
:* High serum [[Ferritin]]
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref> <ref name="pmid191959752" />
* [[Fever]]
* [[Chills]]
* [[Weight loss]]
* [[Night sweats]]
* [[Myalgias]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T21:32:41Z

Sindhuja palle: /* Classification */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classified under Primary cutaneous lymphomas and expresses the TCRαβ phenotype.<ref name="canadiancancer" />

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as: <ref name="pmid191959752">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref>
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="pmid191959753">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref>

The female to male ratio is 2:1.

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules). <ref name="pmid19195975">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* Skin nodules may demonstrate regression with [[lipoatrophy]] at the site of the lesion.
* New nodules can appear at different sites over the course of the disease.
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
:* [[Failure to thrive]]
:* [[Maculopapular rash]]
:* CNS symptoms
:* [[Lymphadenopathy]]
:* [[Coagulopathy]]
:* Abnormal [[Liver function tests|LFT]]<nowiki/>s
:* High serum [[Ferritin]]
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Chills]]
* [[Weight loss]]
* [[Night sweats]]
* [[Myalgias]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T21:07:46Z

Sindhuja palle: /* Differentiating SPTCL from other Diseases */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classified under Primary cutaneous lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as: <ref name="pmid191959752">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref>
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="pmid191959753">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref>

The female to male ratio is 2:1.

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules). <ref name="pmid19195975">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* Skin nodules may demonstrate regression with [[lipoatrophy]] at the site of the lesion.
* New nodules can appear at different sites over the course of the disease.
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
:* [[Failure to thrive]]
:* [[Maculopapular rash]]
:* CNS symptoms
:* [[Lymphadenopathy]]
:* [[Coagulopathy]]
:* Abnormal [[Liver function tests|LFT]]<nowiki/>s
:* High serum [[Ferritin]]
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Chills]]
* [[Weight loss]]
* [[Night sweats]]
* [[Myalgias]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T20:57:56Z

Sindhuja palle: /* Natural History, Complications and Prognosis */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classified under Primary cutaneous lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules). <ref name="pmid19195975">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975 }}</ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* Skin nodules may demonstrate regression with [[lipoatrophy]] at the site of the lesion.
* New nodules can appear at different sites over the course of the disease.
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
:* [[Failure to thrive]]
:* [[Maculopapular rash]]
:* CNS symptoms
:* [[Lymphadenopathy]]
:* [[Coagulopathy]]
:* Abnormal [[Liver function tests|LFT]]<nowiki/>s
:* High serum [[Ferritin]]
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Chills]]
* [[Weight loss]]
* [[Night sweats]]
* [[Myalgias]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T17:20:11Z

Sindhuja palle: /* Classification */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classified under Primary cutaneous lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Chills]]
* [[Weight loss]]
* [[Night sweats]]
* [[Myalgias]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T17:19:34Z

Sindhuja palle: /* Classification */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classifed under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Chills]]
* [[Weight loss]]
* [[Night sweats]]
* [[Myalgias]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T17:18:40Z

Sindhuja palle: /* Symptoms */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classifed under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Subcutaneous panniculitis-like T-cell lymphoma classification'''<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Chills]]
* [[Weight loss]]
* [[Night sweats]]
* [[Myalgias]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T17:16:04Z

Sindhuja palle: /* Differentiating SPTCL from other Diseases */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classifed under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Subcutaneous panniculitis-like T-cell lymphoma classification'''<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* [[Lupus erythematosus panniculitis]]
* [[Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma]]
* [[Primary cutaneous anaplastic large cell lymphoma]]
* [[Mycosis Fungoides]]
* [[Blastic plasmacytoid dendritic cell neoplasm]]
* [[Primary cutaneous lymphomas]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* Chills
* [[Weight loss]]
* [[Night sweats]]
* Myalgias
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-05T06:06:13Z

Sindhuja palle: /* Differentiating SPTCL from other Diseases */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous T-Cell Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classifed under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Subcutaneous panniculitis-like T-cell lymphoma classification'''<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating SPTCL from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Extranodal NK-T-cell lymphoma]]
* Lupus erythematosus panniculitis
* Primary cutaneous CD56+ Natural Killer-like T-Cell lymphoma
* Primary cutaneous anaplastic large cell lymphoma
* Mycosis Fungoides
* Blastic plasmacytoid dendritic cell neoplasm
* Primary cutaneous lymphomas

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma however, many patients have an associated autoimmune disorder at diagnosis.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* Painless nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* The nodules commonly occur in the extremities or trunk. Other areas include: face, neck and back.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare.
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of SPTCL include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* Chills
* [[Weight loss]]
* [[Night sweats]]
* Myalgias
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
'''Abdomen'''
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-04T17:03:55Z

Sindhuja palle: /* Epidemiology and Demographics */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classifed under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Subcutaneous panniculitis-like T-cell lymphoma classification'''<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating type page name here from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Cutaneous T-cell lymphoma]]
* [[Extranodal NK-T-cell lymphoma]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* With subcutaneous panniculitis-like T-cell lymphoma, nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* Usually, the nodules occur in the legs or trunk of the body.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of the subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Weight loss]]
* [[Night sweats]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
====Abdomen====
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-04T16:34:41Z

Sindhuja palle: /* Overview */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, SPTCL is classified under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity from SPTCL, known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]],and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma is classifed under Primary Cutaneous Lymphomas and expresses the TCRαβ phenotype.

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Subcutaneous panniculitis-like T-cell lymphoma classification'''<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating type page name here from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Cutaneous T-cell lymphoma]]
* [[Extranodal NK-T-cell lymphoma]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* With subcutaneous panniculitis-like T-cell lymphoma, nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* Usually, the nodules occur in the legs or trunk of the body.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of the subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Weight loss]]
* [[Night sweats]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
====Abdomen====
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Subcutaneous panniculitis-like T-cell lymphoma

2018-12-04T16:31:31Z

Sindhuja palle: /* Overview */

__NOTOC__
{{SI}}

'''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''

{{CMG}}; {{AE}} {{AS}}

{{SK}} SPTCL; Subcutaneous panniculitis-like T-cell lymphoma alpha/beta subtype; Subcutaneous panniculitis-like T-cell lymphoma gamma/delta subtype; SPTCL-AB; SPTCL-GD

== Overview ==
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of T-cell [[non-Hodgkin lymphoma]] (NHL). Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk. According to the World Health Organization-European Organization for Research and Treatment of Cancer, panniculitis-like T-cell lymphoma is classified under Primary cutaneous lymphomas and expresses the TCRαβ phenotype (SPTCL-AB). TCRγδ phenotypes are now a separate entity known as the Cutaneous γδ T-cell Lymphoma. On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%. Symptoms of the SPTCL include [[fever]], [[weight loss]], [[night sweats]], and painless swellings on extremities and trunk. Subcutaneous nodule biopsy is diagnostic of SPTCL. The predominant therapy for SPTCL is [[chemotherapy]]. Adjunctive [[radiotherapy]] and [[stem cell transplant]] may be required.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref><ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
==Classification==
Subcutaneous panniculitis-like T-cell lymphoma may be classified into either alpha/beta subtype (SPTCL-AB) or gamma/delta subtype (SPTCL-GD).

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Subcutaneous panniculitis-like T-cell lymphoma classification'''<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>
! style="background: #4479BA;; color:#FFF;" | Name
! style="background: #4479BA;; color:#FFF;" | Description
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Alpha/Beta subtype (SPTCL-AB)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Now considered the only type of subcutaneous panniculitis-like T cell lymphoma
* Slow-growing (indolent) disease with a favourable prognosis.
|-
| style="text-align: center; padding: 5px 5px; background: #F5F5F5;" | Gamma/Delta subtype (SPTCL-GD)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Included in the [[cutaneous T-cell lymphoma group]].
* More aggressive type.
* [[Hemophagocytic syndrome]] is most often associated with SPTCL-GD and has a less favourable prognosis.
|}

== Pathophysiology==
Subcutaneous panniculitis-like T-cell lymphoma is a cytotoxic T-cell lymphoma, which preferentially infiltrates subcutaneous tissue, primarily involving the extremities and trunk.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Microscopic Pathology===
On microscopic histopathological analysis, atypical lymphoid cells, [[fat necrosis]], and [[karyorrhexis]] are characteristic findings of subcutaneous panniculitis-like T-cell lymphoma.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
<gallery widths="200px">
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 1 .jpg | Biopsy of soft tissue : at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 2.jpg | Biopsy of soft tissue : at 40x magnification shows lymphoid infiltrate with abundant cytoplasm.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biospy 3.jpg | Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 4.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows numerous single-cell necroses and atypical lymphoid infiltrate.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 5.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure in the center with areas of necrosis and fibrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image: Subcutaneous panniculitis-like T-cell lymphoma biopsy 6.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows mitotic figure with scattered histiocytes and area of necrosis.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
Image:Subcutaneous panniculitis-like T-cell lymphoma biopsy 7.jpg| Biopsy of soft tissue : At 100x magnification with oil-immersion biopsy shows area of necrotic debris.<ref name=hindawi>An Illustrative Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma. Hindawi Publishing Corporation. http://www.hindawi.com/journals/jsc/2011/824528/. Accessed on March 08, 2016 </ref>
</gallery>

==Causes==
There are no established causes for subcutaneous panniculitis-like T-cell lymphoma.
==Differentiating type page name here from other Diseases==
Subcutaneous panniculitis-like T-cell lymphoma must be differentiated from other diseases such as:
* Benign [[panniculitis]]
* [[Cutaneous T-cell lymphoma]]
* [[Extranodal NK-T-cell lymphoma]]

== Epidemiology and Demographics ==
===Age===
Subcutaneous panniculitis-like T-cell lymphoma commonly affects young adults (35 years).<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
===Gender===
Females are more commonly affected with subcutaneous panniculitis-like T-cell lymphoma than males.<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>

== Risk Factors ==
There are no established risk factors for subcutaneous panniculitis-like T-cell lymphoma.
== Screening ==
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for subcutaneous panniculitis-like T-cell lymphoma.<ref name="uspreventive">Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=Subcutaneous+panniculitis-like+T-cell+lymphoma. Accessed on March 8, 2016</ref>

== Natural History, Complications and Prognosis==
* With subcutaneous panniculitis-like T-cell lymphoma, nodules form under the skin in the subcutaneous tissue (subcutaneous nodules).<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref><ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* Usually, the nodules occur in the legs or trunk of the body.
* Skin nodules range in size from 0.5 cm to several centimeters in diameter. Larger nodules may become necrotic, ulceration is rare.
* The infiltrate involves the fat lobules, usually sparing the septa. The overlying dermis and epidermis are typically uninvolved. Dissemination to lymph nodes and other organs is rare
* People with this type of lymphoma can also develop a very serious condition where certain parts of the immune system are activated (hemophagocytic syndrome).
* Hemophagocytic syndrome causes:
:* [[Fever]]
:* Enlarged liver and spleen ([[hepatosplenomegaly]])
:* A lower number of red blood cells, white blood cells and platelets in the blood ([[pancytopenia]])
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary and the 5-year survival rate of patients with subcutaneous panniculitis-like T-cell lymphoma is approximately 80%

== Diagnosis ==
=== Symptoms ===
Symptoms of the subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Fever]]
* [[Weight loss]]
* [[Night sweats]]
* Painless swellings on extremities and trunk
=== Physical Examination ===
====Vitals====
* [[Fever]] is often present
====Skin====
* Subcutaneous nodules
====Abdomen====
* [[Hepatosplenomegaly]]
===Laboratory Findings ===
Laboratory tests for subcutaneous panniculitis-like T-cell lymphoma include:<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016 </ref>
* [[Complete blood count]] (CBC): cytopenia
* Blood chemistry studies: Increased [[liver function tests]]
* Cytogenetic analysis
* [[Flow cytometry]]
* [[Immunophenotyping]]
:* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
:* Negative: [[CD3]]; [[CD5]]; and [[CD56]]
====Biopsy====
Subcutaneous nodule biopsy is diagnostic of subcutaneous panniculitis-like T-cell lymphoma.
==== Other Imaging Findings ====
[[CT]], [[MRI]], and [[PET]] scan may be helpful in the diagnosis of subcutaneous panniculitis-like T-cell lymphoma.

==Treatment==

===Medical Therapy===

{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Treatment of subcutaneous panniculitis-like T-cell lymphoma<ref name="canadiancancer">Subcutaneous panniculitis-like T-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/subcutaneous-panniculitis-like-t-cell-lymphoma/?region=nb. Accessed on March 8, 2016 </ref>'''
! style="background: #4479BA; color:#FFF;" | Therapy
! style="background: #4479BA; color:#FFF;" | Description
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Chemotherapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* Combination therapy :
:* CHOP – [[Cyclophosphamide]] {{and}} [[Doxorubicin]] {{and}} [[Vincristine]] {{and}} [[Prednisone]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Radiation therapy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[External beam radiation therapy]] may be used.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | [[Stem cell transplant]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* May be used in some people with subcutaneous panniculitis-like T-cell lymphoma when their lymphoma recurs after treatment.
|}

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]