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Zhen CJ, Zhang P, Bai WW, Song YZ, Liang JL, Qiao XY, Zhou ZG. Mucosa-associated lymphoid tissue lymphoma of the trachea treated with radiotherapy: A case report. World J Clin Cases 2023; 11:1607-1614. [PMID: 36926401 PMCID: PMC10011992 DOI: 10.12998/wjcc.v11.i7.1607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/04/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphoma originates in the marginal zone of lymphoid tissue. lung is one of the most frequent non-gastrointestinal organs involved, here known as bronchus-associated lymphoid tissue (BALT) lymphoma. BALT lymphoma of unknown etiology, and most patients are asymptomatic. The treatment of BALT lymphoma is controversial.
CASE SUMMARY A 55-year-old man admitted to hospital had a three-month history of progressively coughing up yellow sputum, chest stuffiness, and shortness of breath. Fiberoptic bronchoscopy revealed mucosal visible beaded bumps 4 cm from the tracheal carina at 9 o 'clock and 3 o 'clock, the right main bronchus, and the right upper lobe bronchus. Biopsy specimens showed MALT lymphoma. Computed tomography virtual bronchoscopy (CTVB) showed uneven main bronchial wall thickening and multiple nodular protrusion. BALT lymphoma stage IE was diagnosed after a staging examination. We treated the patient with radiotherapy (RT) alone. A total dose of 30.6 Gy/17 f/25 d was given. The patient had no obvious adverse reactions during RT. The CTVB was repeated after RT and showed that the right side of the trachea was slightly thickened. CTVB was repeated 1.5 mo after RT and again showed that the right side of the trachea was slightly thickened. Annual CTVB showed no signs of recurrence. The patient now has no symptoms.
CONCLUSION BALT lymphoma is an uncommon disease and shows good prognosis. The treatment of BALT lymphoma is controversial. In recent years, less invasive diagnostic and therapeutic approaches have been emerging. RT was effective and safe in our case. The use of CTVB could provide a noninvasive, repeatable, and accurate method in diagnosis and follow-up.
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Affiliation(s)
- Chan-Jun Zhen
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Ping Zhang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Wen-Wen Bai
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Yu-Zhi Song
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Jun-Li Liang
- Nursing Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Xue-Ying Qiao
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhi-Guo Zhou
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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2
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Primary pulmonary mucosa-associated lymphoid tissue lymphoma: A case report. Asian J Surg 2022; 46:2055-2056. [PMID: 36376180 DOI: 10.1016/j.asjsur.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
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3
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Pabst R. The bronchus-associated-lymphoid tissue (BALT) an unique lymphoid organ in man and animals. Ann Anat 2021; 240:151833. [PMID: 34670121 DOI: 10.1016/j.aanat.2021.151833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 01/10/2023]
Abstract
The development structure and number of bronchus-associated lymphoid tissue (BALT) will be described in many different animals (like chicken, rabbit, mouse, rat, farm animals and particular the pig, monkey) and these data compared to healthy man and in human diseases. The term induced BALT should not be used because it is a tertiary lymphoid structure, which lacks the contact to a bronchus and does not consist of the important area (dome area) which is essential for antigen uptake of microbial stimuli, which are essential in the development of BALT. Mycoplasma seems to play a critical role as shown in pigs but there not been documented in other species like rabbits. More studies have to be performed in health and disease (e.g. in apes) to document the structural and functional basis to use BALT as an entry site for vaccination protocols.
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Affiliation(s)
- Reinhard Pabst
- Immunomorphology, Centre of Anatomy, Medical School Hannover, Germany.
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4
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Hosoda C, Ishiguro T, Takahashi N, Kamiishi N, Shimizu Y, Takayanagi N. Spontaneous regression of primary endobronchial extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. Respir Med Case Rep 2019; 27:100826. [PMID: 30963024 PMCID: PMC6434167 DOI: 10.1016/j.rmcr.2019.100826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/09/2019] [Accepted: 03/17/2019] [Indexed: 12/02/2022] Open
Abstract
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of pulmonary origin is a relatively rare disease. In particular, reports of MALT lymphoma occurring and localized in the trachea or bronchus have been limited. Pulmonary MALT lymphoma has been reported to demonstrate spontaneous regression, whereas there is only one reported case of spontaneous regression of primary endobronchial MALT lymphoma. We herein report the case of a 70-year-old man with primary endobronchial MALT lymphoma who showed spontaneous regression with an interest of endobronchial findings.
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Affiliation(s)
- Chiaki Hosoda
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan
| | - Nobumasa Takahashi
- Department of Thoracic Surgery, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan
| | - Nobufumi Kamiishi
- Department of Internal Medicine, Saitama Jikei Hospital, 3-208 Ishihara, Kumagaya, Saitama, 360-0816, Japan
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan
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5
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Mastropasqua R, Agnifili L, Fasanella V, Nubile M, Gnama AA, Falconio G, Perri P, Di Staso S, Mariotti C. The Conjunctiva-Associated Lymphoid Tissue in Chronic Ocular Surface Diseases. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2017; 23:697-707. [PMID: 28480834 DOI: 10.1017/s1431927617000538] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ocular surface diseases (OSDs) represent a widely investigated field of research given their growing incidence and the negative impact on quality of life. During OSDs, cytokines generated by damaged epithelia trigger and deregulate the lymphoid cells composing the eye-associated lymphoid tissues, inducing an immune-mediated chronic inflammation that amplifies and propagates the disease during time. The conjunctiva-associated lymphoid tissue (CALT), given its particular position that permits immune cells covering the cornea, might play a crucial role in the development of OSDs. Despite the recognized inflammatory role of mucosa-associated lymphoid tissues in other stations taking contact with the external environment (gut or bronchus), CALT did not gain the deserved consideration. In the last years, the diffusion of the in vivo confocal microscopy (IVCM) stimulated the interest to CALT, especially in dry eye, ocular allergy, and glaucoma. Though the initial stimuli were different, IVCM documented similar changes, represented by increased lymphoid cells within the diffuse layer, follicles and interfollicular spaces. These findings, which need to be validated by immunohistology, support the CALT stimulation during OSDs. However, while an involvement of the CALT in OSDs is hypothesizable, the exact role of this structure in their pathogenesis remains unclear and warrants further investigations.
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Affiliation(s)
| | - Luca Agnifili
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Vincenzo Fasanella
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Mario Nubile
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Agbeanda A Gnama
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Gennaro Falconio
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Paolo Perri
- 3Department of Biomedical and Surgical Sciences,Division of Ophthalmology,University of Ferrara,Ferrara 44100,Italy
| | - Silvio Di Staso
- 4Department of Surgical Science,Ophthalmic Clinic,University of L'Aquila,L'Aquila 67100,Italy
| | - Cesare Mariotti
- 5Eye Clinic,Polytechnic University of Marche,Ancona 60020,Italy
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6
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Sirajuddin A, Raparia K, Lewis VA, Franks TJ, Dhand S, Galvin JR, White CS. Primary Pulmonary Lymphoid Lesions: Radiologic and Pathologic Findings. Radiographics 2016; 36:53-70. [PMID: 26761531 DOI: 10.1148/rg.2016140339] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The pulmonary lymphoid system is complex and is composed of two compartments: the pulmonary lymphatics and the bronchus-associated lymphoid tissue (BALT). Additional important cells that function in the pulmonary lymphoid system include dendritic cells, Langherhans cells, macrophages, and plasma cells. An appreciation of the normal lymphoid anatomy of the lung as well as its immunology is helpful in understanding the radiologic and pathologic findings of the primary pulmonary lymphoid lesions. Primary lymphoid lesions of the lung arise from the BALT and are uncommon. However, they are increasingly recognized within the growing number of posttransplant patients as well as other patients who are receiving immunosuppressive therapies. Primary lymphoid lesions encompass a wide range of benign and malignant lesions. Benign lymphoid lesions of the lung include reactive lymphoid hyperplasia, follicular bronchiolitis, lymphoid interstitial pneumonia, and nodular lymphoid hyperplasia. Malignant lymphoid lesions of the lung include low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), other non-Hodgkin lymphomas, and Hodgkin lymphoma. Last, a miscellaneous group of primary lymphoid lesions includes lymphomatoid granulomatosis, posttransplant lymphoproliferative disorders, acquired immunodeficiency syndrome (AIDS)-related lymphoma, and intravascular lymphoma/lymphomatosis. These lesions are best evaluated with multidetector chest computed tomography. The radiologic findings of the primary lymphoid lesions are often nonspecific and are best interpreted in correlation with clinical data and pathologic findings. The purpose of this article is to review pulmonary lymphoid anatomy as well as the most common primary pulmonary lymphoid disorders.
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Affiliation(s)
- Arlene Sirajuddin
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Kirtee Raparia
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Vanessa A Lewis
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Sabeen Dhand
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Charles S White
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
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7
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Stolagiewicz N, Tinwel B, Cormack IS, Lucas SB, Devaraj A, Kay-Loke T, Chua F. Spontaneous pneumothorax in a 50-year-old man with diffuse pulmonary nodules. Chest 2013; 143:1174-1179. [PMID: 23546494 DOI: 10.1378/chest.12-0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Brendan Tinwel
- Pathology Department, Croydon University Hospital, Croydon
| | - Ian S Cormack
- Department of Genito-Urinary Medicine, Croydon University Hospital, Croydon
| | - Sebastian B Lucas
- Histopathology Department, School of Medicine, King's College London, London, England
| | - Anand Devaraj
- Radiology Department, St. George's Hospital NHS Trust, London
| | - Tuck Kay-Loke
- Department of Respiratory Medicine, Croydon University Hospital, Croydon
| | - Felix Chua
- Respiratory Medicine Department, Croydon University Hospital, Croydon
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Ding J, Chen Z, Shi M. Tracheal stenting for primary tracheal mucosa-associated lymphoid tissue lymphoma. Eur J Med Res 2013; 18:8. [PMID: 23547898 PMCID: PMC3621548 DOI: 10.1186/2047-783x-18-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022] Open
Abstract
Primary tracheal mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. We report a 49-year-old female patient with the complaint of dyspnea. Fiberoptic bronchoscopy showed polypoid, variable-sized and irregular nodules causing narrowing of the tracheal lumen from the proximal trachea to the left main bronchus. Because of severe stenosis in the airway and the severity of symptoms, this case was unresectable. The patient was then treated successfully with placement of an endobronchial stent through bronchofibroscopy. After the placement of the stent, bronchoscopic biopsy was performed. Pathological analysis confirms a diagnosis of MALT-associated malignant lymphoma. We performed systemic chemotherapy on the patient. The temporary stent was removed after the reduction of the stenosis. This is the first case in which tracheal MALT lymphoma was treated successfully following tracheal stent insertion guided by bronchofibroscopy. Temporary tracheal stenting can be a favorable choice for a patient with tracheal stenosis caused by primary tracheal MALT lymphoma.
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Affiliation(s)
- Juanjuan Ding
- Respiratory Department, HeNan Provincial People's Hospital, No 7 Weiwu Road, Zhengzhou 450003, China.
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Swarup R. Bronchus-associated lymphoid tissue lymphoma stage IV with subsequent histologic transformation to an aggressive lymphoma: A case report. J Med Case Rep 2011; 5:455. [PMID: 21910879 PMCID: PMC3179457 DOI: 10.1186/1752-1947-5-455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 09/12/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Extranodal marginal B-cell lymphoma of bronchus-associated lymphoid tissue is a rare entity accounting for less than 1% of all lymphomas. We report a case of a low-grade bronchus-associated lymphoid tissue lymphoma stage IV with transformation to an aggressive large B-cell lymphoma. Case presentation A 59-year-old African-American man was incidentally found to have a bronchus-associated lymphoid tissue lymphoma involving the bilateral lower lobes of his lungs. In addition, bone marrow involvement was discovered. His course was indolent with only some mild respiratory symptoms. He received single agent treatment with rituximab. No evidence of progression was seen at the end of receiving this regimen. Two years after treatment our patient presented with B symptoms. Imaging now showed significant increase in the size of the lung masses with cavitation of the right lower lobe mass. A repeat transbronchial biopsy suggested transformation to an aggressive diffuse large B-cell lymphoma. Conclusion This case illustrates a rare bronchus-associated lymphoid tissue lymphoma stage IV with histologic transformation to an aggressive lymphoma. In addition, this rare case of transformation presented as a cavitary lesion.
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Affiliation(s)
- Rajeev Swarup
- Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.
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10
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Mucosa-associated lymphoid tissue lymphoma of the left mainstem bronchus. Ann Thorac Surg 2011; 91:1281-3. [PMID: 21440165 DOI: 10.1016/j.athoracsur.2010.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/02/2010] [Accepted: 10/01/2010] [Indexed: 12/14/2022]
Abstract
Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the large airway is extremely rare. We report a patient in whom we performed a sleeve resection of the left main bronchus without resection of lung parenchyma for MALT lymphoma. During restaging of the disease, tumor cells were detected in the bone marrow, and the patient subsequently underwent systemic chemotherapy with anti-CD20 antibody. The patient currently remains free of recurrence. Local resection of bronchial MALT lymphoma is very important to avoid airway difficulties. In addition, although MALT lymphoma of the bronchus appears to be localized, systemic spread of the disease must be considered and investigated.
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