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We read with interest the case report by Orchard et al on non-Hodgkin’s lymphoma arising in cryptogenic fibrosing alveolitis (CFA).1 Although the authors state that this has not been described previously, we recently reported six cases of pulmonary B cell non-Hodgkin’s lymphomas arising in patients with autoimmune disorders, three of whom had CFA.2 As in the case described by Orchard et al, prognosis in these three patients was much poorer than that in the patients with high grade pulmonary non-Hodgkin’s lymphomas unassociated with CFA, presumably due to the combined effects of the two diseases.
author’s reply We are grateful to Dr Nicholson and Professor Corrin for pointing out their very interesting report, which was published after the original writing of our case report.
In the patient we reported the association was with cryptogenic fibrosing alveolitis (CFA) alone whereas, interestingly, the three patients they report had CFA associated with other systemic autoimmune disorders. The fact that CFA alone may be associated with B cell lymphomas, and the poorer prognosis seen by Nicholson and Corrin in their patients, as well as ours, supports the hypothesis that chronic local stimulation of the lymphoid system may play an important part in the aetiology and prognosis of these tumours.
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