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Gao LR, Wang X, Wu Y, Feng XL, Rao W, Liu X, Song YW, Fang H, Chen B, Jin J, Liu YP, Jing H, Tang Y, Lu NN, Li N, Zhang WW, Zhai Y, Wang SL, Qi SN, Li YX. Treatment outcome, toxicity, and quality of life of patients with bronchus-associated lymphoid tissue lymphoma. Leuk Lymphoma 2024; 65:746-757. [PMID: 38506231 DOI: 10.1080/10428194.2024.2329328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
The disease failure patterns and optimal treatment of bronchus-associated lymphoid tissue (BALT) lymphoma are unknown. This retrospective study involved 71 patients with primary BALT lymphoma who had received radiotherapy (RT), surgery, immunochemotherapy (IC), or observation. The median follow-up time was 66 months. The 5-year overall survival and lymphoma-specific survival were 91.2% and 96.1%, respectively, and were not significantly different among treatments. The 5-year cumulative incidence of overall failure for RT, surgery, IC, and observation was 0%, 9.7% (p = .160), 30.8% (p = .017), and 31.3% (p = .039). There was no grade ≥3 toxicity in RT group according to the CTCAE 5.0 reporting system. Quality of life (QoL) was at similarly good levels among the treatment groups. BALT lymphoma had a favorable prognosis but persistent risk of relapse after IC or observation. Given the very low disease failure risk and good QoL, RT remains an effective initial treatment for BALT lymphoma.
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Affiliation(s)
- Lin-Rui Gao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xinyue Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yunpeng Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xiao-Li Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Wei Rao
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xin Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
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Kiełbowski K, Kordykiewicz D, Jesionka J, Wójcik J, Ptaszyński K, Kostopanagiotou K, Waloszczyk P, Wojtyś ME. A Rare Case of Primary Pulmonary Diffuse Large B-Cell Lymphoma Transformed from Marginal Zone Mucosa-Associated Lymphoid Tissue Lymphoma. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:840. [PMID: 38929457 PMCID: PMC11205931 DOI: 10.3390/medicina60060840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024]
Abstract
Primary pulmonary lymphoma is a rare neoplasm characterized by the proliferation of lymphoid tissue affecting the lungs. The most common subtype is marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). Rarely, a MALT lymphoma transforms into a diffuse large B-cell lymphoma (DLBCL). Treatment options include chemotherapy, radiotherapy, immunotherapy, and surgery. Here, we describe a patient with a primary pulmonary MALT lymphoma transforming into DLBCL. The purpose of this case report is to raise awareness of the relevant clinical and imaging features and to emphasize the need for a multidisciplinary approach to optimal management. In addition, we screened the PubMed and Embase databases for similar reports with a confirmed presence of transforming lymphoma within the lungs.
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Affiliation(s)
- Kajetan Kiełbowski
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Dawid Kordykiewicz
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Janusz Jesionka
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Konrad Ptaszyński
- Department of Pathology and Forensic Medicine, University of Warmia and Mazury Olsztyn, 11-082 Olsztyn, Poland
| | | | - Piotr Waloszczyk
- Independent Laboratory of Pathology, Zdunomed, Energetyków 2, 70-656 Szczecin, Poland
| | - Małgorzata Edyta Wojtyś
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
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Le Y, Zhu H, Ye C, Lin J, Wang N, Yang T. CT radiomics analysis discriminates pulmonary lesions in patients with pulmonary MALT lymphoma and non-pulmonary MALT lymphoma. Methods 2024; 224:54-62. [PMID: 38369073 DOI: 10.1016/j.ymeth.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE The aim of this study is to create and validate a radiomics model based on CT scans, enabling the distinction between pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma and other pulmonary lesion causes. METHODS Patients diagnosed with primary pulmonary MALT lymphoma and lung infections at Fuzhou Pulmonary Hospital were randomly assigned to either a training group or a validation group. Meanwhile, individuals diagnosed with primary pulmonary MALT lymphoma and lung infections at Fujian Provincial Cancer Hospital were chosen as the external test group. We employed ITK-SNAP software for delineating the Region of Interest (ROI) within the images. Subsequently, we extracted radiomics features and convolutional neural networks using PyRadiomics, a component of the Onekey AI software suite. Relevant radiomic features were selected to build an intelligent diagnostic prediction model utilizing CT images, and the model's efficacy was assessed in both the validation group and the external test group. RESULTS Leveraging radiomics, ten distinct features were carefully chosen for analysis. Subsequently, this study employed the machine learning techniques of Logistic Regression (LR), Support Vector Machine (SVM), and k-Nearest Neighbors (KNN) to construct models using these ten selected radiomics features within the training groups. Among these, SVM exhibited the highest performance, achieving an accuracy of 0.868, 0.870, and 0.90 on the training, validation, and external testing groups, respectively. For LR, the accuracy was 0.837, 0.863, and 0.90 on the training, validation, and external testing groups, respectively. For KNN, the accuracy was 0.884, 0.859, and 0.790 on the training, validation, and external testing groups, respectively. CONCLUSION We established a noninvasive radiomics model utilizing CT imaging to diagnose pulmonary MALT lymphoma associated with pulmonary lesions. This model presents a promising adjunct tool to enhance diagnostic specificity for pulmonary MALT lymphoma, particularly in populations where pulmonary lesion changes may be attributed to other causes.
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Affiliation(s)
- Yuyin Le
- Department of Hematology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China; Department of Oncology Medicine, Fuzhou Pulmonary Hospital of Fujian Province, The Teaching Hospital of Fujian Medical University, 2 Hubian Rd, 350001 Fuzhou, Fujian, China
| | - Haojie Zhu
- Department of Hematology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Chenjing Ye
- Fujian Medical University, Fuzhou, Fujian, China
| | - Jiexiang Lin
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Nila Wang
- Department of Oncology Medicine, Fuzhou Pulmonary Hospital of Fujian Province, The Teaching Hospital of Fujian Medical University, 2 Hubian Rd, 350001 Fuzhou, Fujian, China
| | - Ting Yang
- Department of Hematology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China; Institute of Precision Medicine, Fujian Medical University, Fuzhou 350005, China.
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Rechal R, Prasad VP, Sethi S, Maturu VN. Non-resolving pneumonia: primary pulmonary MALT lymphoma. BMJ Case Rep 2024; 17:e255075. [PMID: 38458766 PMCID: PMC10928793 DOI: 10.1136/bcr-2023-255075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is an uncommon extranodal low-grade B-cell lymphoma. Pulmonary MALT lymphomas originate from bronchial MALT and are also referred to as bronchial-associated lymphoid tissue lymphomas. MALT lymphomas of the lung are slow-growing tumours and usually present as asymptomatic chronic alveolar opacities visible on chest radiographs or with non-specific pulmonary symptoms. Here we described a case of a male patient in his early 50s with cough and chest pain for 4 years. His CT chest scan showed consolidation in the lingula and left lower lobe. Histopathology of the specimen obtained from cryobiopsy of the lung lesion showed a dense monomorphic lymphoid infiltrate, and immunohistochemistry confirmed the diagnosis of MALT lymphoma. The prognosis of pulmonary MALT lymphomas is good with >80% 5-year survival rates. This case highlights that MALT lymphoma should be considered as a differential diagnosis while evaluating cases with non-resolving consolidation.
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Affiliation(s)
- Rinoosha Rechal
- Department of Pulmonary Medicine, Yashoda Group of Hospitals, Hyderabad, Telangana, India
| | | | - Shweta Sethi
- Department of Pathology, Yashoda Group of Hospitals, Hyderabad, Telangana, India
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Freret ME, Tringale KR, Boe L, Imber BS, Joffe E, Yahalom J, Hajj C. Very low-dose radiotherapy for extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue. Leuk Lymphoma 2023; 64:2195-2201. [PMID: 37706509 PMCID: PMC10962616 DOI: 10.1080/10428194.2023.2255706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
Extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue (BALT) is a rare cancer for which optimal treatment strategies are undefined. Retrospective analyses suggest excellent outcomes with surgical resection for localized BALT lymphoma; however, the role of radiotherapy remains underexplored. We report the largest-to-date single-center analysis of 13 primary BALT lymphoma patients treated with radiotherapy. Of 15 treated lesions, we report a 100% response rate with complete response (CR) achieved in 67% of lesions. Among 10 lesions treated with very low-dose radiotherapy (VLDRT; 4 Gray [Gy]), 6 (60%) achieved a CR; among 5 lesions treated with full-dose radiotherapy (24-36 Gy), 4 (80%) achieved a CR. There were no local recurrences. Only one patient, treated with 30 Gy, developed an acute grade 3/4 toxic effect. There were no events of radiation-induced secondary malignancies. Our institutional experience indicates that radiotherapy, including VLDRT, is a safe and effective treatment for primary BALT lymphoma.
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Affiliation(s)
- Morgan E. Freret
- Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Kathryn R. Tringale
- Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Lillian Boe
- Epidemiology and Biostatistics, MSKCC, New York, NY, USA
| | - Brandon S. Imber
- Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Erel Joffe
- Lymphoma Service, MSKCC, New York, NY, USA
| | - Joachim Yahalom
- Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Carla Hajj
- Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
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Huang L, Chen T, Liang G, Rueckert JC, He J, Zhou H, Xie X. A case report of minimally invasive surgical resection for pulmonary mucosa-associated lymphoid tissue. JTCVS Tech 2023; 22:281-284. [PMID: 38152236 PMCID: PMC10750462 DOI: 10.1016/j.xjtc.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/07/2023] [Accepted: 08/10/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Luyu Huang
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Tianqing Chen
- Department of Thoracic Surgery, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong Province, China
| | - Guozhong Liang
- Department of Thoracic Surgery, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong Province, China
| | - Jens C. Rueckert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Junxiu He
- St George's University School of Medicine, True Blue, Grenada
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoping Xie
- Department of Thoracic Surgery, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong Province, China
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Dong C, Xia P, Qiu W, Dai Z, Wang Z. Evaluation of CT features for differentiating consolidation pattern of pulmonary MALT lymphoma from pneumonic-type lung adenocarcinoma. Front Oncol 2023; 13:1234291. [PMID: 37727207 PMCID: PMC10505754 DOI: 10.3389/fonc.2023.1234291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose In clinical practice, the consolidation pattern of pulmonary mucosa-associated lymphoid tissue (C-MALT) was often misdiagnosed as pneumonic-type lung adenocarcinoma (P-LADC). However, the mainstay of treatment and prognosis of these two diseases are different. The purpose of this study was to distinguish C-MALT from P-LADC by pre-treatment chest computed tomography (CT) features. Patients and methods A total of 31 patients with C-MALT (15 men and 16 women; mean age, 61.1 ± 11.2 years) and 58 patients with P-LADC (34 men and 24 women; mean age, 68.6 ± 7.4 years) confirmed by pathology who underwent contrast-enhanced chest CT were retrospectively enrolled from September 2014 to February 2023. Detailed clinical and CT characteristics of the two groups were evaluated. Logistic regression analysis was used to assess the effectiveness of statistically significant variables in distinguishing C-MALT from P-LADC. Results The average age of C-MALT was younger than P-LADC patients (p<0.001). With regard to CT features, bronchiectasis within the consolidation was more common in the C-MALT group than the P-LADC group [83.87% (26 of 31) vs 20.69% (12 of 58), p<0.001]; whereas lymph nodes enlargement [75.86% (44 of 58) vs 9.68% (3 of 31), p<0.001] and pleural effusion [43.10% (25of 58) vs 19.35% (6 of 31), p=0.025] were more frequently observed in the P-LADC group than C-MALT group. The predictors with p<0.05 (age, bronchiectasis, lymph node enlargement, and pleural effusion) were used to construct a logistic regression model in discriminating C-MALT from P-LADC, the area under curve (AUC), positive predictive value (PPV), negative predictive value (NPV), specificity, sensitivity, and accuracy were 0.9555, 86.67%, 91.53%, 83.87%, 93.10%, and 89.89%, respectively. Conclusion C-MALT and P-LADC have differential clinical and CT features. An adequate understanding of these different characteristics can contribute to the early accurate diagnosis of C-MALT and provide an appropriate therapeutic strategy.
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Affiliation(s)
- Congsong Dong
- Department of Radiology, The Six Affiliated Hospital of Nantong University (Yancheng Third People’s Hospital), Yancheng, China
| | - Peng Xia
- Department of Radiology, Wuxi Traditional Chinese Medicine (TCM) Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Wenli Qiu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhenyu Dai
- Department of Radiology, The Six Affiliated Hospital of Nantong University (Yancheng Third People’s Hospital), Yancheng, China
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Kou L, Huan N, Nyanti LE, Chin JS, Mohamad NB, Ramarmuty HY. Pulmonary extra-nodal mucosa-associated lymphoid tissue (MALT) lymphoma: A rare cause of persistent lung consolidation. Respirol Case Rep 2023; 11:e01197. [PMID: 37501686 PMCID: PMC10368649 DOI: 10.1002/rcr2.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
Pulmonary extra-nodal marginal zone B-cell lymphoma, also known as extra-nodal mucosa-associated lymphoid tissue (MALT) lymphoma, is rare among all non-Hodgkin lymphomas and generally among all pulmonary malignancies. We present a 46-year-old lady with persistent right lower lung consolidation despite earlier treatment efforts with intravenous antibiotics for community acquired pneumonia. Apart from initial presentation with a short 3-day history of fever, cough and shortness of breath, she had remained largely asymptomatic throughout the follow-up period. Flexible bronchoscopy done ruled out infectious aetiologies but transbronchial lung biopsies showed atypical lymphocytes. A computed tomography guided core biopsy of her right lung consolidation was subsequently performed, confirming a diagnosis of pulmonary MALT lymphoma. She was promptly referred to the haematology team for further management and commencement of chemotherapy. Pulmonary MALT lymphoma, albeit uncommon and often follows a relatively indolent cause, should be considered as a differential diagnosis among patients with persistent lung consolidation.
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Affiliation(s)
- Lily Kou
- Department of MedicineKeningau HospitalKeningauMalaysia
| | - Nai‐Chien Huan
- Department of Respiratory MedicineQueen Elizabeth HospitalKota KinabaluMalaysia
| | - Larry Ellee Nyanti
- Medical Department, Faculty of Medicine and Health SciencesUniversiti Malaysia SabahKota KinabaluMalaysia
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Yu X, Kang B, Nie P, Deng Y, Liu Z, Mao N, An Y, Xu J, Huang C, Huang Y, Zhang Y, Hou Y, Zhang L, Sun Z, Zhu B, Shi R, Zhang S, Sun C, Wang X. Development and validation of a CT-based radiomics model for differentiating pneumonia-like primary pulmonary lymphoma from infectious pneumonia: A multicenter study. Chin Med J (Engl) 2023; 136:1188-1197. [PMID: 37083119 PMCID: PMC10278712 DOI: 10.1097/cm9.0000000000002671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia. METHODS In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared. RESULTS A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05). CONCLUSIONS The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
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Affiliation(s)
- Xinxin Yu
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Bing Kang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Yan Deng
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Zixin Liu
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 446701, Republic of Korea
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, Shandong 164000, China
| | - Yahui An
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing 100080, China
| | - Jingxu Xu
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing 100080, China
| | - Chencui Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing 100080, China
| | - Yong Huang
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China
| | - Yonggao Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Zhanguo Sun
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China
| | - Baosen Zhu
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Rongchao Shi
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Shuai Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Cong Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
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Hua J, Lia Z, Ma C, Zhang X, Li Q, Duan X, Xiao T, Geng X. Risk factors analysis and establishment of predictive nomogram of extranodal B-cell lymphoma of mucosal-associated lymphoid tissue. Cancer Radiother 2023; 27:126-135. [PMID: 36894407 DOI: 10.1016/j.canrad.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 03/09/2023]
Abstract
PURPOSE The role of radiation therapy in mucosa-associated lymphoid tissue (MALT) lymphoma is poorly defined. The objective of this study was to explore the factors associated with the performance of radiotherapy and to assess its prognostic impact in patients with MALT lymphoma. PATIENTS AND METHODS Patients with MALT lymphoma diagnosed between 1992 and 2017 were identified in the US Surveillance, Epidemiology, and End Results database (SEER). Factors associated with the delivery of radiotherapy were assessed by chi-square test. Overall survival (OS) and lymphoma-specific survival (LSS) were compared between patients with and without radiotherapy, using Cox proportional hazard regression models, in patients with early stage as well as those with advanced stage. RESULTS Of the 10,344 patients identified with a diagnosis of MALT lymphoma, 33.6% had received radiotherapy; this rate was 38.9% for stage I/II patients and 12.0% for stage III/IV patients, respectively. Older patients and those who already received primary surgery or chemotherapy had a significantly lower rate of receiving radiotherapy, regardless of lymphoma stage. After univariate and multivariate analysis, radiotherapy was associated with improved OS and LSS in patients with stage I/II (HR=0.71 [0.65-0.78]) and (HR=0.66 [0.59-0.74]), respectively, but not in patients with stage III/IV (HR=1.01 [0.80-1.26]) and (HR=0.93 [0.67-1.29]). The nomogram built from the significant prognostic factors associated with overall survival of stage I/II patients had a good concordance (C-index=0.749±0.002). CONCLUSION This cohort study shows that radiotherapy is significantly associated with a better prognosis in patients with early but not advanced MALT lymphoma. Prospective studies are needed to confirm the prognostic impact of radiotherapy in patients with MALT lymphoma.
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Affiliation(s)
- J Hua
- Department of Hematology, Liaocheng People's Hospital, Shan Dong, China
| | - Z Lia
- Department of Hematology, Liaocheng People's Hospital, Shan Dong, China
| | - C Ma
- Department of Hematology, Liaocheng People's Hospital, Shan Dong, China
| | - X Zhang
- Department of Hematology, Liaocheng People's Hospital, Shan Dong, China
| | - Q Li
- Department of Hematology, Liaocheng People's Hospital, Shan Dong, China
| | - X Duan
- Department of Hematology, Liaocheng People's Hospital, Shan Dong, China
| | - T Xiao
- Department of Hematology, Liaocheng People's Hospital, Shan Dong, China
| | - X Geng
- Department of Radiotherapy, Liaocheng People's Hospital, 252000 Shan Dong, China.
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Peng Y, Qi W, Luo Z, Zeng Q, Huang Y, Wang Y, Sharma A, Schmidt-Wolf IGH, Liao F. Role of 18F-FDG PET/CT in patients affected by pulmonary primary lymphoma. Front Oncol 2022; 12:973109. [PMID: 36185301 PMCID: PMC9515576 DOI: 10.3389/fonc.2022.973109] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Primary pulmonary lymphoma (PPL) is defined as clonal abnormal hyperplasia of lung parenchyma or bronchial lymphoid tissue originating from bronchial mucosal tissue. However, PPL is rare, which accounts for approximately 3-4% of extraneurotic lymphomas and 0.5-1% of all primary tumors in the lung. Owing to the lack of any typical clinical symptoms and radiological features, it is challenging to accurately diagnose PPL, which affects its clinical management and prognosis. Considering this, herein, we aim to raise awareness of this disease and help physicians understand the role of 18F-FDG PET/CT in the diagnosis of PPL. Method A retrospective analysis was performed on the clinical and 18F-FDG PET/CT imaging data of 19 patients diagnosed with PPL by biopsy pathology at our hospital from April 2014 to December 2021. Results Of the 19 PPL patients, 15 patients showed clinical symptoms with the most common being fever and cough. In addition, there were 4 cases that had no clinical symptoms, and all of them were MALT lymphoma. In fact, 16 patients were misdiagnosed as lobar pneumonia, lung cancer, tuberculosis, and diffuse interstitial inflammation, representing a misdiagnosis rate of 84.2%. Also, 73.7% were MALT lymphomas, representing the most common pathological pattern, along with 3 DLBCL and 2 T-cell lymphomas. With reguard to CT signs, the air-bronchial sign was found to be the most common, followed by the halo sign and the collapsed leaf sign. On the basis of the predominant radiologic features, lesions were categorized as pneumonic consolidation, nodular/mass type, diffuse interstitial type, and mixed type. The average SUVmax of lesions was 7.23 ± 4.75, the ratio of SUVmax (lesion/liver) was 3.46 ± 2.25, and the ratio of SUVmax (lesion/mediastinal blood pool) was found to be 5.25 ± 3.27. Of interest, the different pathological types of PPL showed different values of 18F-FDG uptake. The 18F-FDG uptake of DLCBL was the most prominent with a SUVmax of 15.33 ± 6.30 and was higher than that of MALT lymphoma with a SUVmax of 5.74 ± 2.65. There appeared similarity in 18F-FDG uptake between MALT lymphoma and T-cell lymphoma. For the SUVmax of lesion, we found statistical significance between MALT lymphoma and DLCBL (P value<0.001). In addition, we also found statistical significance (P value < 0.05) in SUVmax of lesions between pneumonic consolidation type and nodal/mass type, I stage, and other stages. Conclusions On 18F-FDG PET/CT images, certain features of PPL morphology and metabolism can be identified that may contribute to a better understanding of this disease. In addition, 18F-FDG PET/CT whole-body imaging has the potential to refine the staging of PPL. Most importantly, functional 18F-FDG PET/CT imaging can readily reflect tumor cell activity, thus allowing for the selection of an optimal biopsy site.
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Affiliation(s)
- Ying Peng
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Wanling Qi
- Department of Nuclear Medicine, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhehuang Luo
- Department of Nuclear Medicine, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Qingyun Zeng
- Department of Nuclear Medicine, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yujuan Huang
- Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yulu Wang
- Department of Integrated Oncology, Center for Integrated Oncology (CIO), University Hospital Bonn, Bonn, Germany
| | - Amit Sharma
- Department of Integrated Oncology, Center for Integrated Oncology (CIO), University Hospital Bonn, Bonn, Germany
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Ingo G. H. Schmidt-Wolf
- Department of Integrated Oncology, Center for Integrated Oncology (CIO), University Hospital Bonn, Bonn, Germany
| | - Fengxiang Liao
- Department of Nuclear Medicine, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- *Correspondence: Fengxiang Liao,
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12
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Di Rocco A, Petrucci L, Assanto GM, Martelli M, Pulsoni A. Extranodal Marginal Zone Lymphoma: Pathogenesis, Diagnosis and Treatment. Cancers (Basel) 2022; 14:cancers14071742. [PMID: 35406516 PMCID: PMC8997163 DOI: 10.3390/cancers14071742] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Extranodal marginal zone lymphoma (EMZL) is an indolent lymphoproliferative disease morphologically composed of small heterogeneous B lymphocytes. It generally occurs with a localized stage and can arise in various organs, the most frequent being the stomach, lung, and ocular adnexa. Depending on the presentation and the possible association with infectious agents, different therapeutic approaches are to be undertaken. The purpose of this review is to describe the biology underlying this pathology, the diagnostic, and therapeutic approach. Abstract Extranodal Marginal Zone Lymphoma (EMZL lymphoma) is an indolent B-cell lymphoma with a median age at diagnosis of about 60 years. It accounts for 7–8% of all B-cell lymphomas. It can occur in various extranodal sites, including stomach, lung, ocular adnexa, and skin; furthermore, the disseminated disease can be found in 25–50% of cases. Several infectious agents, such as Helicobacter pylori (H. Pylori) in the case of gastric Mucosa Associated Lymphoid Tissue (MALT) Lymphoma, can drive the pathogenesis of this cancer, through the autoantigenic stimulation of T cells, but there may also be other factors participating such autoimmune diseases. Initial staging should include total body computed tomography, bone marrow aspirate, and endoscopic investigation if indicated. Fluorescence in situ hybridization (FISH), should be performed to detect the presence of specific chromosomal translocations involving the MALT1 and BCL10 genes, which leads to the activation of the NF-κB signaling pathway. Depending on the location and dissemination of the disease, different therapeutic choices may include targeted therapy against the etiopathogenetic agent, radiotherapy, immunochemotherapy, and biological drugs. The purpose of this review is to illustrate the complex biology and the diagnosis of this disease and to better define new treatment strategies.
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Shen H, Zhou Y. Clinical Features and Surgical Treatment of Primary Pulmonary Lymphoma: A Retrospective Study. Front Oncol 2022; 12:779395. [PMID: 35186728 PMCID: PMC8850835 DOI: 10.3389/fonc.2022.779395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background Primary pulmonary lymphoma (PPL) is a rare clonal lymphoproliferative lung disease. The present study analyzes the clinical features, imaging data, pathologic characteristics, treatment, and prognosis of PPL patients, with the aim to discuss the appropriate diagnosis and therapy of PPL patients in thoracic surgery. Methods We performed a retrospective analysis on 36 patients with PPL confirmed by postoperative pathology between 2006 and 2020. We divided the patients into low-stage (IE) and high-stage (IIE) groups using modified Ann Arbor staging. The clinical manifestations, imaging findings, treatment modalities, and outcomes were evaluated. Results The female to male ratio was 1.57:1 and the median age was 55 (31–69) years old. The majority of the patients had stage IE disease (75%; 27 of 36) and 9 patients had stage IIE disease. Patients with advancing stage were more likely to have respiratory symptoms. The imaging findings presented solid nodule or mass, pneumonia-like consolidative pattern, ground-glass opacity, and mixed pattern. There were 31 cases of mucosa-associated lymphoid tissue lymphoma (MALT), 2 diffuse large B-cell lymphoma (DLBCL), 2 nodular sclerosing Hodgkin’s lymphoma, and 1 marginal zone B-cell lymphoma. Two patients were diagnosed with PPL and non-small cell lung cancer (NSCLC) synchronously (one AIS and MIS and one lung adenocarcinoma). All the patients received surgery. Nine patients received adjuvant therapy after surgery (five radiotherapy, two chemotherapy, and two chemoradiotherapy). Thirty-four patients had a median follow-up time of 31 months (follow-up range: 7–152 months). Of the 34 patients, 1 patient died of liver metastases and 1 patient died of intestinal metastases. Conclusions Our retrospective analysis suggested that most PPLs were indolent and had favorable prognosis, but the discrimination of PPL with other lung diseases was difficult. Preoperative biopsy and intraoperative frozen section examination might help in the surgical choice. Limited lung resection was enough for peripherally localized PPL.
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14
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Qiu W, Chen H, Zhang J, Shuai R, Zhang H, Guo K, Zhu L, Wang Z. Evaluation of HRCT for the Differential Diagnosis of Pneumonia-Like Consolidation Pattern of Pulmonary MALT Lymphoma from Lobar Pneumonia. Cancer Manag Res 2021; 13:7813-7821. [PMID: 34675676 PMCID: PMC8520482 DOI: 10.2147/cmar.s327846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/04/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To assess the performance of high-resolution computed tomography (HRCT) in discriminating the consolidation pattern of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma from lobar pneumonia. Patients and Methods This retrospective study comprised 26 patients with pathologically confirmed consolidation pattern of pulmonary MALT lymphoma (12 men and 14 women; mean age, 59.4±12.1 years) and 36 patients with lobar pneumonia confirmed by body fluids or respiratory secretion culture (16 men and 20 women; mean age, 41.8±26.3 years). Two radiologists independently evaluated the CT images. The effectiveness of these variables in distinguishing lobar pneumonia from MALT lymphoma was analyzed using logistic regression analysis. Results The average age of lobar pneumonia patients was younger than that of MALT lymphoma patients (p=0.002). The respiratory symptom was more common in lobar pneumonia than MALT lymphoma (p=0.002). Signs of bronchiectasis within the consolidation and bulging of interlobar fissure occurred significantly more often in MALT lymphoma than pneumonia (69.2% vs 11.1%, p<0.0001; 46.2% vs 19.4%, p=0.024). We used the predictors with p<0.05 (age, respiratory symptoms, bronchiectasis, and bulging of interlobar fissure) to construct a logistic regression model. The area under curve (AUC), negative predictive value (NPV), positive predictive value (PPV), sensitivity, specificity, and accuracy were 0.891, 84.21%, 83.33%, 88.89%, 76.92%, and 83.87% for discriminating lobar pneumonia from MALT lymphoma. Conclusion Middle-aged, presence of mild clinical symptoms, bronchiectasis and bulging of the interlobar fissure on chest CT images are potential markers to distinguish pulmonary MALT lymphoma from lobar pneumonia.
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Affiliation(s)
- Wenli Qiu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Haibin Chen
- Science and Technology Department, Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine Prevention and Treatment of Tumor, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Jian Zhang
- Department of Radiology, Liyang Traditional Chinese Medicine Hospital, Changzhou, Jiangsu, People's Republic of China
| | - Ren Shuai
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Huifeng Zhang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Kai Guo
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Li Zhu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
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Isolated lobar consolidation as a form of presentation of pulmonary MALT lymphoma. Med Clin (Barc) 2021; 158:298. [PMID: 34272067 DOI: 10.1016/j.medcli.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022]
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16
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Active surveillance of primary extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue. Blood Adv 2021; 5:345-351. [PMID: 33496731 DOI: 10.1182/bloodadvances.2020003213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022] Open
Abstract
Although patients with bronchus-associated lymphoid tissue (BALT) lymphoma show an indolent clinical course, appropriate disease management at diagnosis is not well defined. This study aimed to compare 3 treatment strategies for patients with BALT lymphoma: active surveillance, systemic chemotherapy or immunotherapy at diagnosis, or complete surgical resection at diagnosis. We conducted a retrospective study of all patients with new diagnoses of marginal zone lymphoma (MZL) involving the lung who were treated at the Memorial Sloan Kettering Cancer Center between 1995 and 2017. Primary BALT lymphoma was defined as disease confined to the lungs and adjacent lymph nodes. Active surveillance was defined as a documented observation plan and ≥3 months of follow-up before initiating treatment. Overall survival (OS) and event-free survival (EFS) were compared between treatment groups. We reviewed 200 consecutive patients with MZL involving the lung; 123 met the inclusion criteria and were managed by active surveillance (47%), complete surgical resection (41%), or systemic chemotherapy or immunotherapy (11%). With a median follow-up of >60 months, surgical resection was associated with a superior EFS compared with active surveillance and systemic treatment (6-year EFS: 74% vs 65% vs 62%, respectively; P = .013). Larger lesions and thrombocytopenia were associated with shorter EFS. All groups had excellent OS at 6 years (93%), albeit with a slight superiority for surgical resection (100%) over active surveillance (91%) and systemic treatment (76%) (P = .024). BALT lymphoma is an indolent disease that can often be managed expectantly and not require therapy for many years.
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17
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Green DB, Restrepo CS, Legasto AC, Bang TJ, Oh AS, Vargas D. Imaging of the rare cystic lung diseases. Curr Probl Diagn Radiol 2021; 51:648-658. [PMID: 33618900 DOI: 10.1067/j.cpradiol.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
When discussing cystic lung diseases, a certain group of diseases tends to receive the majority of attention. Other less frequently discussed cystic lung diseases are also important causes of morbidity in patients. Etiologies include genetic syndromes, lymphoproliferative diseases, infections, exogenous exposures, and a developmental abnormality. This review article focuses on the clinical and imaging features of these other cystic lung diseases.
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Affiliation(s)
- Daniel B Green
- Department of Radiology, Weill Cornell Medicine, New York, NY.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Tami J Bang
- Department of Radiology, University of Colorado, Aurora, CO
| | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO
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Bi W, Zhao S, Wu C, Gao J, Zhao S, Yang S, Deng Y, Nie P, Yu X, Deng H, Zang X, Ma X, Han J, Asuquo I, Wang X, Xue X. Pulmonary mucosa-associated lymphoid tissue lymphoma: CT findings and pathological basis. J Surg Oncol 2021; 123:1336-1344. [PMID: 33523526 DOI: 10.1002/jso.26403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/25/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) is the most frequent subset of primary pulmonary lymphoma. This study aimed to identify radiologic characteristics of pulmonary MALToma based on computed tomography (CT) observations and pathologic features, and further investigate its prognosis. METHODS Sixty-six patients (55.4 ± 10.9 years; 51.5% male) diagnosed as pulmonary MALToma by pathology were retrospectively enrolled. According to distributions and features of lesions shown on CT, patients were divided into three patterns, including single nodular/mass, multiple nodular/mass, and pneumonia-like consolidative. RESULTS Variety of the location and extent of the lymphomatous infiltration accounted for different characteristics demonstrated at CT. The pneumonia-like consolidative pattern was the most frequent pattern observed in 42 patients (63.6%), followed by single nodular/mass (21.2%) and multiple nodular/mass (15.2%). CT features included air bronchogram (72.7%), well-marginated halo sign (53.0%), coarse spiculate with different lengths (72.7%), angiogram sign (77.1% of 35 patients), peribronchovascular thickening (48.5%), irregular cavitation (16.7%) and pulmonary cyst (7.6%). The estimated 5-year cumulative overall survival rate of pulmonary MALToma was 100.0%. CONCLUSIONS Pulmonary MALToma demonstrates several characteristics at CT. Identification of the significant pulmonary abnormalities of this indolent disease entity might be helpful for early diagnosis and optimal treatment.
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Affiliation(s)
- Wanli Bi
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Shuo Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chongchong Wu
- Department of Radiology, The Chinese PLA General Hospital, Beijing, China
| | - Jie Gao
- Department of Pathology, The Chinese PLA General Hospital, Beijing, China
| | - Shaohong Zhao
- Department of Radiology, The Chinese PLA General Hospital, Beijing, China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yan Deng
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinxin Yu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hui Deng
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xuelei Zang
- Department of Microbiology, The Chinese PLA General Hospital, Beijing, China
| | - Xidong Ma
- Department of Respiratory Disease, School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, China
| | - Jun Han
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Idorenyin Asuquo
- Department of and Respiratory, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xinying Xue
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Peking University Ninth School of Clinical Medicine, Beijing, China
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, Beijing, China
- Affiliated Hospital of Weifang Medical University, Shandong, China
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Yan W, Wu B, Liao AJ, Yang W, Wang HH. Watch-and-wait or immediate immunotherapy/immunochemotherapy in patients with phase IE primary pulmonary MALT lymphoma? A multicenter retrospective study. Ann Hematol 2021; 100:709-714. [PMID: 33483774 DOI: 10.1007/s00277-021-04396-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/03/2021] [Indexed: 01/24/2023]
Abstract
Primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is rare, and the optimal frontline treatment has not taken shape so far. It is still debatable whether the watch-and-wait (W&W) policy is beneficial to patients, especially in the early stage. This study was to compare the efficacy of W&W with rituximab single agent or combined chemotherapy (R/R-Chemo) on primary pulmonary MALT patients with localized disease. Clinical characters and effect on 28 patients with primary pulmonary MALT (IE phase) were analyzed. Among the 28 patients, 14 were grouped into W&W cohort, and 14 were immediately treated with R/R-Chemo. The median follow-up duration was 62 months. The estimated median time to treatment failure (TTF) in the W&W cohort and immediate R/R-Chemo cohort was 29 months and 59 months, which were not significantly different (P = 0.667). The estimated median time of overall survival (OS) in the W&W cohort and immediate R/R-Chemo cohort was 78 months and 76 months, which were also not statistically significant (P = 0.696). Concerning prognosis, there is no difference between patients with primary pulmonary MALT (IE phase) treated with W&W and with timely R/R-Chemo.
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Affiliation(s)
- Wei Yan
- Department of Hematology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110000, Liaoning, China
| | - Bin Wu
- Department of Hematology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110000, Liaoning, China
| | - Ai-Jun Liao
- Department of Hematology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110000, Liaoning, China
| | - Wei Yang
- Department of Hematology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110000, Liaoning, China
| | - Hui-Han Wang
- Department of Hematology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110000, Liaoning, China.
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Santopietro M, Kovalchuk S, Battistini R, Puccini B, Annibali O, Romano I, Zoli V, Avvisati G, Bosi A, Rigacci L. Treatment and prognosis of primary pulmonary lymphoma: A long-term follow-up study. Eur J Haematol 2020; 106:49-57. [PMID: 32779796 DOI: 10.1111/ejh.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
Primary pulmonary lymphoma (PPL) is a rare disease with not well-defined optimal treatment. Outcomes and follow-up are variable in published data. OBJECTIVES To define the outcome and optimal treatment strategies in PPL. METHODS We reviewed the medical records of 49 patients with PPL treated in three Italian Hematological Institutions between 2002 and 2018. RESULTS Thirty-eight (77.5%) cases were indolent PPL, and 11 (22.5%) cases were aggressive PPL. The majority of patients were asymptomatic at diagnosis, early stages (stages IE-IIE), normal serum LDH, no bone marrow involvement, and low or low-intermediate risks of IPI. Local therapy ± immunotherapy or immuno-chemotherapy was possible in 18/49 (37%) patients. Twenty-eight (57%) patients were treated with immuno-chemotherapy after biopsy. Waiting and watching were reported in 3 (6%) patients. Overall, the CR and ORR were 83.7% and 95.9%. With a median follow-up of 62.5 months (range 0.8-199 months), the estimated 5- and 10-year OS rates were 85% and 72.3% for all patients, 89.2% and 80.3% for indolent PPL, and 70.7% and 47.1% for aggressive PPL. Aggressive PPL tended to have a high risk of progression in the first months (P = .056). No advantages were found for indolent PPL who received immuno-chemotherapy or more conservative approaches. CONCLUSION Our studies confirm the epidemiological and favorable survival of patients with PPL, suggesting a very conservative approach, particularly in indolent subtypes.
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Affiliation(s)
- Michelina Santopietro
- Haematology and Haematopoietic Stem Cells Transplant Unit, AO San Camillo-Forlanini, Rome, Italy
| | | | - Roberta Battistini
- Haematology and Haematopoietic Stem Cells Transplant Unit, AO San Camillo-Forlanini, Rome, Italy
| | | | - Ombretta Annibali
- Unit of Haematology and Stem Cell Transplantation, Campus Bio-Medico University, Rome, Italy
| | | | - Valerio Zoli
- Haematology and Haematopoietic Stem Cells Transplant Unit, AO San Camillo-Forlanini, Rome, Italy
| | - Giuseppe Avvisati
- Unit of Haematology and Stem Cell Transplantation, Campus Bio-Medico University, Rome, Italy
| | - Alberto Bosi
- Unit of Haematology, AOU Careggi, Florence, Italy
| | - Luigi Rigacci
- Haematology and Haematopoietic Stem Cells Transplant Unit, AO San Camillo-Forlanini, Rome, Italy.,Unit of Haematology, AOU Careggi, Florence, Italy
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Investigation of the treatment modality in primary lymphoma of the salivary glands. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:248-255. [PMID: 32681985 DOI: 10.1016/j.jormas.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/24/2020] [Accepted: 07/09/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To review our experience in managing primary lymphoma of the major salivary glands by analysing the treatment modality of patients. METHODS In this study, we reviewed the medical records of 26 patients with primary malignant lymphoma of the major salivary glands who were treated at Beijing Stomatological Hospital of Capital Medical University from January 1999 to March 2015. The predictor variable was treatment modality. The outcome variables were overall survival (OS), disease-free survival (DFS), disease-special survival (DSS) and local control (LC). Other relevant variables were as follows: age, sex, pathological pattern, tumour site, clinical features, source, IPI and Ann-Arbor stage. The data were analysed by the χ2 test, log-rank test, and univariate analysis. RESULTS Of the 26 patients, 14 received surgery only, four received initial surgery combined with adjuvant radiotherapy, five received adjuvant chemotherapy, and three received adjuvant radiochemotherapy. During the median follow-up period of 104 months, the overall estimates of OS, DFS, DSS and LC were 84.6, 84.6, 88.5 and 92.3%, respectively. Good outcomes were achieved in patients who received surgery combined with postoperative RT, followed by surgery only. MALT lymphoma had a better prognosis than the other pathological patterns. Mass, swelling, pathological pattern and Ann-Arbor stage were important prognostic factors. CONCLUSION Surgery combined with postoperative radiotherapy may be an appropriate choice for patients with MALT lymphoma. The pathological pattern, mass, swelling and Ann-Arbor stage were associated with an unfavourable prognosis.
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Wang L, Ye G, Liu Z, Shi L, Zhan C, Gu J, Luo R, Lin Z, Ge D, Wang Q. Clinical characteristics, diagnosis, treatment, and prognostic factors of pulmonary mucosa-associated lymphoid tissue-derived lymphoma. Cancer Med 2019; 8:7660-7668. [PMID: 31691549 PMCID: PMC6912039 DOI: 10.1002/cam4.2683] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/21/2019] [Accepted: 10/21/2019] [Indexed: 01/22/2023] Open
Abstract
Primary pulmonary mucosa‐associated lymphoid tissue‐derived (MALT) lymphoma is a rare disease with a favorable prognosis. However, its clinical characteristics, diagnosis, treatment, and prognoses remain unclear. We retrospectively analyzed 80 patients with pathologically confirmed MALT lymphoma from 2006 to 2018. The clinical characteristics, diagnosis, treatments, and prognoses of all the 80 patients were recorded. Patients were stratified into surgery and biopsy groups, respectively, to evaluate the role of surgery in the diagnosis and treatment of MALT lymphoma. The prognoses were compared between different clinical characteristics and treatments. Pathological diagnoses were confirmed by surgery, bronchoscopy, and percutaneous biopsy. Thirty patients were treated by surgery. While MALT lymphoma was only diagnosed by bronchofiberoscopy or bercutaneous biopsy in four of 18 patients in the surgery group who underwent the procedure. Six patients received adjuvant chemotherapy and one patient received involved‐field radiotherapy in surgery group. Thirty‐one patients were treated with chemotherapy alone, one patient was treated with radiotherapy, one patient received only symptomatic and supportive treatment, and waiting and watching without treatment were recommended in 17 patients in biopsy group. Eight patients died during follow‐up and the 5‐year survival rate was 87.1%. Tumor number, treatment, and age were prognostic factors for overall survival (OS), but age was the only independent prognostic factor according to multivariate analysis. While, tumor number was the only prognostic factor in the analysis about progression‐free survival (PFS). No significant difference was found in OS or PFS between patients treated with and without surgical resection. MALT lymphoma is an indolent disease with favorable treatment outcome. Tumor number is associated with PFS and age is the only significant prognostic factor for pulmonary MALT lymphoma patients because of its indolent nature, but surgery still plays an important role in the diagnosis and treatment of MALT lymphoma.
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Affiliation(s)
- Lin Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guanzhi Ye
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhonghe Liu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Shi
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Gu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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