Radiological and histopathological features and treatment response by subtypes of interstitial pneumonia with autoimmune features: A prospective, multicentre cohort study.

BACKGROUND: Patients with idiopathic interstitial pneumonia (IIP) have a favourable prognosis when they have interstitial pneumonia with autoimmune features (IPAF). However, precise IPAF-related findings from high-resolution computed tomography (HRCT) and lung histopathological specimens and the treatment response have not been fully determined. Therefore, this study was conducted to evaluate the relationship between findings on HRCT or lung histopathological specimens and the progression of interstitial pneumonia in patients with IPAF. METHODS: This multicentre cohort study prospectively enrolled consecutive patients with IIP. At the diagnosis of IIP, we systematically evaluated 74 features suggestive of connective tissue diseases and followed them up. HRCT, lung specimens, serum antibodies, and the clinical course were also evaluated. RESULTS: Among 222 patients with IIP, 26 (11.7%) fulfilled the IPAF criteria. During a median observation period of 36 months, patients with IPAF showed better survival than those without IPAF (p = 0.034). While histopathological findings were not related to IPAF, nonspecific interstitial pneumonia (NSIP) with organizing pneumonia (OP) overlap was the most prevalent HRCT pattern (p < 0.001) and the consolidation opacity was the most common radiological finding in IPAF (p = 0.017). Furthermore, in patients with IPAF, the diagnosis of COP or NSIP with OP overlap was associated with a higher increase in %FVC in 1 year than in those with idiopathic pulmonary fibrosis, NSIP, or unclassifiable IIP (p = 0.002). CONCLUSIONS: This study shows the presence of consolidation opacity on HRCT and the diagnosis of COP or NSIP with OP overlap are associated with IPAF and its favourable treatment response in patients with IPAF.

CD8-positive peripheral T cell lymphoma in a patient following long-term nivolumab for advanced lung adenocarcinoma: A case report.

A 54-year-old male smoker presented with hemoptysis. Advanced lung adenocarcinoma, cT1cN3M1b, stage IVB, was diagnosed. Enlargement of multiple intraperitoneal and inguinal lymph nodes and peripheral atypical lymphocytosis appeared after 33 cycles of second-line treatment with nivolumab, and a specimen obtained by left inguinal lymph node biopsy showed peripheral T cell lymphoma (PTCL), not otherwise specified. Lymphoma cells expressed CD3+, CD8+, and CD56+, but not CD4+ or PD-1. Despite systemic chemotherapy with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone, the patient died of PTCL 864 days after the initial visit. The possible relationship between treatment with immune checkpoint inhibitors (ICIs) and PTCL development is discussed here.