ADONIS 030901 679100039V Histopathologu 1991. 18, 211-219 Pathology of the lung in leukaemia and lymphoma: a study of 87 autopsies zyxw H.M.DORAN, M.N.SHEPPARD*, P.W.COLLINSt, L.JONESt, A.C.NEWLANDt zy & J.D.VAN DER WALT zyxwvuts Departments of Histopathology, The Royal London and * Brompton Hospitals and t Department of Haematology, The Royal London Hospital, London, UK Date of submission 22 May 1990 Accepted for publication 26 September 1990 DORAN H.M., SHEPPARD M.N., COLLINS P.W., JONES L., NEWLAND A.C. & VAN DER WALT J.D. (1991) Histopathology 18, 211-219 Pathology of the lung in leukaemia and lymphoma: a study of 87 autopsies Histopathologicalfindings in the lungs in a series of autopsies on 8 7 patients suffering from various types of leukaemia or lymphoma who had received no treatment, or various combinations of radiotherapy, chemotherapy and bone marrow transplantation were reviewed. Thirteen untreated patients showed neoplastic infiltration (4), thrombo- embolism (4), infection (5) or amyloidosis (1). Seventy-two treated cases showed malignant infiltration (14), vascular damage (21), infections (32) and/or diffuse alveolar damage (47). One patient treated with local irradiation for myeloma had acute bronchopneumonia alone and another treated with [ 32P] for polycythaemia rubra Vera had extensive thrombo-embolism of the large pulmonary vessels. Clinical and autopsy evidence of infection correlated very poorly. Non-infective pulmonary disease was a frequent finding. Bacterial, fungal or pneumocystis pneumonia particularly affected the chemotherapy and radiotherapy groups, while cytomegalovirus infection was seen only in the bone marrow transplant group. This study shows that diffuse alveolar damage is a common and important problem in patients treated with radiotherapy and chemotherapy. Keywords: lung, leukaemia, lymphoma, radiotherapy, chemotherapy, bone marrow transplant Introduction Patients suffering from leukaemia or lymphoma fre- quently die in respiratory failure. At autopsy, we have observed a wide range of florid microscopical change in the lung which in many cases could not be attributed either to malignant infiltration nor an identifiable infection. The pulmonary changes often differed in nature or degree of severity from those expected from the clinical assessment. In this study we have examined the histopathological findings in the lungs in a series of 87 autopsies on patients suffering from various types of leukaemia or lymphoma who had received no treatment or various combinations of radiotherapy, chemotherapy and bone marrow transplantation, attempting to assess the rela- Address for correspondence: Dr J.D.vander Walt, Institute of Pathology, The Royal London Hospital, Whitechapel, London El 1BB. UK. tive contributions of the original disease and the different therapeutic regimes. Materials and methods Between January 1983 andDecember 1989,91 patients with diagnoses of leukaemia or lymphoma established before or after death came to autopsy at The Royal London Hospital. Relevant clinical details were obtained from the hospital records. All the original sections were reviewed. Four of the 91 cases were excluded, two because no clinical information was available and two because no lung blocks could be found. The 8 7 remaining cases had various types of leukae- mia and lymphoma (Table 1). They were divided according to the type of treatment, and the histological findings in each group were compared. In the earlier part of the series, representative blocks had been taken from the lungs, while in the latter part, the lungs had been fixed by inflation with formalin at approximately 2 5 cm 211