Oka M, Kawano K, Kanda T, Hara K
Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Am Rev Respir Dis. 1988 Apr;137(4):957-9. doi: 10.1164/ajrccm/137.4.957.
We performed bronchoalveolar lavage in a patient with pulmonary lymphoma and IgM lambda monoclonal serum gammopathy previously not diagnosed accurately by histologic examination and not treated for 5 yr after detection of a pulmonary infiltrate. The infiltrate increased slowly in size accompanied by coughing and sputum and a gradual increase in serum IgM throughout the 5-yr period. High IgM in the lavage fluid was noted with an IgM/albumin ratio 4.8 times higher in the lavage fluid than in the serum. Protein immunoelectrophoresis of the lavage fluid was identical to that of the serum. A primary pulmonary lymphoma was diagnosed on the basis of findings in the lavage fluid. The patient showed decreased serum IgM and marked improvement of the infiltrate by chemotherapy and radiation. Thus, bronchoalveolar lavage, including analysis of the proteins in lavage fluids, appears to be a simple and useful method for diagnosing primary pulmonary lymphomas.
我们对一名患有肺淋巴瘤和IgM λ单克隆血清丙种球蛋白病的患者进行了支气管肺泡灌洗。该患者此前经组织学检查未得到准确诊断，在发现肺部浸润后5年未接受治疗。在这5年期间，肺部浸润灶大小缓慢增加，伴有咳嗽、咳痰，血清IgM逐渐升高。灌洗液中IgM水平较高，灌洗液中IgM/白蛋白比值比血清中高4.8倍。灌洗液的蛋白质免疫电泳与血清相同。根据灌洗液检查结果诊断为原发性肺淋巴瘤。经化疗和放疗后，患者血清IgM降低，肺部浸润灶明显改善。因此，支气管肺泡灌洗，包括对灌洗液中的蛋白质进行分析，似乎是诊断原发性肺淋巴瘤的一种简单而有用的方法。
