1
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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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2
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Pina-Oviedo S, Roggli VL, Sporn TA, Li H, Glass C, DiBernardo LR, Pavlisko EN. Diagnostic Approach to Pulmonary B-Cell Lymphomas in Small Biopsies, with Practical Recommendations to Avoid Misinterpretation. Diagnostics (Basel) 2023; 13:3321. [PMID: 37958219 PMCID: PMC10650405 DOI: 10.3390/diagnostics13213321] [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: 10/01/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Pulmonary lymphomas are rare. With the current less invasive approaches used to obtain material for diagnosis, the diagnosis of pulmonary lymphoma is now frequently established in a small biopsy rather than in a resection. Therefore, the diagnosis has become more challenging and requires correlation with the clinico-radiologic presentation and with ancillary studies (immunohistochemistry, flow cytometry, cytogenetics, and/or molecular analysis). Due to the rarity of pulmonary lymphomas, clinical suspicion of a lymphomatous process is low at initial presentation, and material may be only submitted for histopathology. For this reason, herein, we provide recommendations to arrive at the correct diagnosis of the most common lung B-cell lymphomas (marginal zone lymphoma of mucosa-associated lymphoid tissue, diffuse large B-cell lymphoma, intravascular large B-cell lymphoma, lymphomatoid granulomatosis) in the setting of small biopsies, utilizing only immunohistochemistry. The differential diagnosis varies according to the lymphoma subtype and includes reactive conditions, solid tumors, and other hematolymphoid malignancies. Although morphology and immunohistochemistry may be sufficient to establish a diagnosis, in some cases, the best recommendation is to obtain additional tissue via a VATS biopsy/wedge resection with material submitted for flow cytometry, cytogenetics, and/or molecular studies to be able to properly classify a pulmonary lymphoid process.
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Affiliation(s)
- Sergio Pina-Oviedo
- Department of Pathology, Duke University Medical Center, Durham, NC 27710-4000, USA (E.N.P.)
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3
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Gozzi L, Cozzi D, Cavigli E, Moroni C, Giannessi C, Zantonelli G, Smorchkova O, Ruzga R, Danti G, Bertelli E, Luzzi V, Pasini V, Miele V. Primary Lymphoproliferative Lung Diseases: Imaging and Multidisciplinary Approach. Diagnostics (Basel) 2023; 13:diagnostics13071360. [PMID: 37046580 PMCID: PMC10093093 DOI: 10.3390/diagnostics13071360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Lymphoproliferative lung diseases are a heterogeneous group of disorders characterized by primary or secondary involvement of the lung. Primary pulmonary lymphomas are the most common type, representing 0.5–1% of all primary malignancies of the lung. The radiological presentation is often heterogeneous and non-specific: consolidations, masses, and nodules are the most common findings, followed by ground-glass opacities and interstitial involvement, more common in secondary lung lymphomas. These findings usually show a prevalent perilymphatic spread along bronchovascular bundles, without a prevalence in the upper or lower lung lobes. An ancillary sign, such as a “halo sign”, “reverse halo sign”, air bronchogram, or CT angiogram sign, may be present and can help rule out a differential diagnosis. Since a wide spectrum of pulmonary parenchymal diseases may mimic lymphoma, a correct clinical evaluation and a multidisciplinary approach are mandatory. In this sense, despite High-Resolution Computer Tomography (HRCT) representing the gold standard, a tissue sample is needed for a certain and definitive diagnosis. Cryobiopsy is a relatively new technique that permits the obtaining of a larger amount of tissue without significant artifacts, and is less invasive and more precise than surgical biopsy.
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Affiliation(s)
- Luca Gozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Edoardo Cavigli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | | | - Giulia Zantonelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Olga Smorchkova
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ron Ruzga
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ginevra Danti
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Valentina Luzzi
- Interventional Pneumology, Careggi University Hospital, 50134 Florence, Italy
| | - Valeria Pasini
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, 50133 Florence, Italy
| | - Vittorio Miele
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
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4
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Galoppini G, Maranini B, Ciancio G, Padovan M, Casoni GL, Cavazzini F, Gafà R, Lanza G, Govoni M. Extranodal localization of non-Hodgkin's lymphoma in systemic sclerosis: A diagnostic challenge and review of the literature. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:NP1-NP6. [PMID: 36211199 PMCID: PMC9537711 DOI: 10.1177/23971983221088459] [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: 02/16/2022] [Accepted: 03/01/2022] [Indexed: 10/03/2023]
Abstract
Background Systemic sclerosis is associated with an increased incidence of malignancies, in particular solid neoplasms. Hematological cancers have been also observed in autoimmune diseases, though rarely present with lung involvement. The latter may be misdiagnosed in systemic sclerosis patients, due to the frequent concomitant interstitial lung disease. Case description Here, we present the case of a 63-year-old man affected by systemic sclerosis presenting with an atypical lung imaging and splenomegaly, who was diagnosed with splenic marginal zone lymphoma, thus raising the suspicion of lung secondarism. We discuss the diagnostic challenge of differential diagnosis in interstitial lung presentation and briefly review the available literature on this topic. Conclusion Several reports have demonstrated an increased risk of malignancy in patients with systemic sclerosis. Still, the lack of concretely defined guidelines for systemic sclerosis, along with systemic sclerosis multifaceted organ involvement at presentation, may challenge diagnosis and management. Here, we remark the importance of clinical work-up and a multidisciplinary approach in systemic sclerosis, to early detect and treat concomitant hematological malignancies, especially during the first years of the disease.
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Affiliation(s)
- Giorgio Galoppini
- Rheumatology Unit, Department of
Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Beatrice Maranini
- Rheumatology Unit, Department of
Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Ciancio
- Rheumatology Unit, Department of
Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Melissa Padovan
- Rheumatology Unit, Department of
Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Francesco Cavazzini
- Hematology Unit, Department of Medical
Sciences, University of Ferrara, Ferrara, Italy
| | - Roberta Gafà
- Pathology Unit, Department of Medical
Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Lanza
- Pathology Unit, Department of Medical
Sciences, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of
Medical Sciences, University of Ferrara, Ferrara, Italy
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5
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Chan P, Li A. Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma presented as cystic lung disease – a case report in Tuen Mun Hospital Hong Kong. Radiol Case Rep 2022; 17:3457-3460. [PMID: 35912290 PMCID: PMC9334922 DOI: 10.1016/j.radcr.2022.06.064] [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: 05/01/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
We report a rare case of pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) in a 52-year-old woman presented as cystic lung disease together with ground-glass lesion on computed tomography (CT) of the thorax incidentally found as part of workup for organ donation.
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6
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Shiono A, Imai H, Satou T, Taguchi R, Takahashi N, Azuma R, Yamaguchi O, Hashimoto K, Naito E, Iemura H, Miura Y, Mouri A, Kaira K, Kobayashi K, Kagamu H. Metachronous lesions in the orbit, retroperitoneum, and pleura of mucosa‐associated lymphoid tissue lymphoma: A case report. Cancer Rep (Hoboken) 2022; 5:e1689. [PMID: 35899993 PMCID: PMC9575486 DOI: 10.1002/cnr2.1689] [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: 09/03/2021] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ayako Shiono
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Tsugumi Satou
- Department of Pathology, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Ryo Taguchi
- Department of Thoracic Surgery Comprehensive Cancer Center, International Medical Center, Saitama Medical University Hidaka Japan
| | - Naoki Takahashi
- Department of Hematopoietic Tumor Comprehensive Cancer Center, International Medical Center, Saitama Medical University Hidaka Japan
| | - Ryuichi Azuma
- Department of Plastic Surgery National Defense Medical College Tokorozawa Japan
| | - Ou Yamaguchi
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Kosuke Hashimoto
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Erika Naito
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Hidetoshi Iemura
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Yu Miura
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Atsuto Mouri
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center International Medical Center, Saitama Medical University Hidaka Japan
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7
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With the Increasing Health Awareness: Clinical and Computed Tomography Findings in Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Lymphoma. J Comput Assist Tomogr 2022; 46:894-899. [PMID: 35985053 DOI: 10.1097/rct.0000000000001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study is to investigate the clinical manifestations, computed tomography (CT) findings, and prognosis of primary pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) with the improved health awareness nowadays. METHODS Clinical data and CT images of patients with pathologically confirmed MALToma from October 2012 to October 2021 were retrospectively analyzed. RESULTS Eighteen MALToma patients were included in the study (8 men and 10 women; mean age, 56.17 years; range, 33-73 years). Six men had a long-term history of smoking (>20 years). One patient had an autoimmune disease (Sjögren syndrome). Eight patients (44.44%) were asymptomatic, and 10 (55.56%) had mild chest or systemic symptoms. Most lesions (88.89%) were subpleural or located along the bronchovascular tree. According to the CT characteristics, the lesions were divided into 4 groups: nodular type (n = 8; 44.44%, including 5 solid nodules and 3 ground-glass nodules), mass type (n = 4, 22.22%), patch or consolidate type (n = 5, 27.78%), and mixed type (n = 1, 5.56%). Air bronchogram (11/18, 61.11%) and angiogram sign (8/16, 50%) were the most frequent CT findings and may help differential diagnosis. The patients were misdiagnosed with lung cancer (n = 11, 61.11%), inflammatory or chronic inflammatory disease (n = 4, 22.22%), bronchiectasis accompanied by infection (n = 1, 5.56%), diffuse interstitial lung disease (n = 1, 5.56%), and granuloma or tuberculosis (n = 1, 5.56%). The prognosis of all patients was favorable; 1 patient was lost to follow-up. CONCLUSIONS Nowadays, patients with MALToma are usually asymptomatic or paucisymptomatic. Nodular lesions, including ground-glass nodules, are the most common presentation. Mucosa-associated lymphoid tissue lymphoma is most likely misdiagnosed as lung cancer. Lesions located in the subpleural areas or along the bronchovascular tree and presenting with an air bronchogram or angiogram sign could indicate a MALToma diagnosis.
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8
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Lin N, Xie H, Zhang W, Ma X. The Central Cavitation in Pulmonary Diffuse Large B-Cell Lymphoma Detected by 18F-FDG PET/CT. Clin Nucl Med 2022; 47:562-563. [PMID: 35439180 DOI: 10.1097/rlu.0000000000004173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACT Primary pulmonary diffuse large B-cell lymphoma is a rare type of extranodal lymphoma with PET/CT manifestations of consolidations, ground-glass opacities, and high 18F-FDG uptake. Because of its rarity and the lack of typical imaging features, it can hardly be diagnosed through PET/CT. The central cavitation was occasionally seen in pulmonary diffuse large B-cell lymphoma and may be a key imaging feature in differential diagnoses. In this report, we describe an 80-year-old man diagnosed as having pulmonary diffuse large B-cell lymphoma, which demonstrated the central cavitation detected by 18F-FDG PET/CT.
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Affiliation(s)
- Nan Lin
- From the Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University
| | - Hangyu Xie
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wenjie Zhang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Xuelei Ma
- From the Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University
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9
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Tanahashi H, Yamaguchi K, Koura T, Kambara T, Yamada K, Sakamoto S, Horimasu Y, Masuda T, Miyamoto S, Nakashima T, Iwamoto H, Fukushima N, Fujitaka K, Hamada H, Ichinohe T, Ohshima K, Hattori N. Primary Pulmonary Mucosa-associated Lymphoid Tissue Lymphoma with the High Expression of IgG4. Intern Med 2022; 61:1043-1048. [PMID: 34544945 PMCID: PMC9038459 DOI: 10.2169/internalmedicine.7436-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This is the first report describing primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma with the high expression of IgG4. The histological findings were compatible with the diagnostic criteria for MALT lymphoma and IgG4-related respiratory disease (IgG4-RRD). An unfixed sample for Southern blotting was not obtained since computed tomography findings showed multiple lung cysts, which is rare in patients with MALT lymphoma. However, polymerase chain reaction using paraffin sections showed the clonality of the immunoglobulin heavy chain variable region gene rearrangement, confirming a diagnosis of MALT lymphoma. This is an instructive case in which primary pulmonary MALT lymphoma was histologically compatible with IgG4-RRD.
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Affiliation(s)
- Hiroki Tanahashi
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Kakuhiro Yamaguchi
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Tomoko Koura
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Takahiro Kambara
- Department of Pathology, Hiroshima University Graduate School of Biomedical and Health Science, Japan
| | - Kyohei Yamada
- Department of Pathology, Kurume University School of Medicine, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Yasushi Horimasu
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Takeshi Masuda
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Taku Nakashima
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Hiroshi Iwamoto
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | | | - Kazunori Fujitaka
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Hironobu Hamada
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
| | - Tatsuo Ichinohe
- Department of Hematology, Hiroshima University Hospital, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Japan
| | - Noboru Hattori
- Department of Respiratory Medicine, Hiroshima University Hospital, Japan
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10
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Wu T, Huang Y, Wang Z, Cao H, Ding Q, Deng Z. Pulmonary MALT lymphoma: imaging findings in 18 cases and the associated pathological correlations. Am J Med Sci 2022; 364:192-197. [DOI: 10.1016/j.amjms.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/01/2022]
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11
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Kido T, Ishimoto H, Ishii H, Hara K, Ozasa M, Kawabata H, Kawanami T, Suzuki Y, Yoshikawa H, Hara A, Sakamoto N, Matsumoto N, Yoshii C, Fukuoka J, Fujita M, Nakazato M, Kadota J, Mukae H, Yatera K. Combined detection of lymphocyte clonality and MALT1 translocations in bronchoalveolar lavage fluid for diagnosing pulmonary lymphomas. Sci Rep 2021; 11:23430. [PMID: 34873224 PMCID: PMC8648835 DOI: 10.1038/s41598-021-02861-4] [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: 05/29/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Diagnosis of pulmonary lymphoma using small tissue samples is difficult and often requires surgical procedures; thus, a less invasive sampling method is desirable. We previously showed that pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma can be diagnosed by detecting MALT lymphoma translocation gene 1 (MALT1) translocations in bronchoalveolar lavage fluid (BALF) cells. Analysis of B-cell clonality based on immunoglobulin heavy chain (IGH) gene rearrangements was also reportedly useful for diagnosing pulmonary lymphoma. The aim of this prospective multicenter study was to evaluate the yet unknown diagnostic potential of combined detection of MALT1 translocations and clonality using BALF. We analyzed B- and T-cell clonality based on IGH and T-cell receptor (TCR) rearrangements together with MALT1 translocations using BALF of patients with clinically suspected pulmonary lymphomas. In total, 39 patients were evaluated and categorized into three groups: B-cell lymphoma, lymphoproliferative disorders, and other diseases. IGH rearrangement detection for B-cell lymphoma diagnosis exhibited sensitivity and specificity of 88.9% and 90.0%, respectively. TCR rearrangements were not observed in patients with B-cell lymphomas. The presence of IGH rearrangements together with the absence of TCR rearrangements indicated 96.0% specificity for the diagnosis of B-cell lymphoma. The sensitivity and specificity of MALT1 translocations for diagnosing MALT lymphoma were 28.6% and 100%, respectively. The combined detection of lymphocyte clonality and MALT1 translocations using BALF is suitable for screening and diagnosis of B-cell lymphomas. Analysis of specific genes such as MALT1 should improve the precision of B-cell lymphoma diagnosis.
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Affiliation(s)
- Takashi Kido
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan. .,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kanako Hara
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Mutsumi Ozasa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.,Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Kawabata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Toshinori Kawanami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yu Suzuki
- Department of Respiratory Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Yoshikawa
- Department of Respiratory Medicine and Infectious Disease, Faculty of Medicine, Oita University, Yufu, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Nobuhiro Matsumoto
- Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Chiharu Yoshii
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Masamitsu Nakazato
- Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Junichi Kadota
- Department of Respiratory Medicine and Infectious Disease, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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12
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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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13
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Depascale R, Del Frate G, Gasparotto M, Manfrè V, Gatto M, Iaccarino L, Quartuccio L, De Vita S, Doria A. Diagnosis and management of lung involvement in systemic lupus erythematosus and Sjögren's syndrome: a literature review. Ther Adv Musculoskelet Dis 2021; 13:1759720X211040696. [PMID: 34616495 PMCID: PMC8488521 DOI: 10.1177/1759720x211040696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
Lung involvement in systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS) has extensively been outlined with a multiplicity of different manifestations. In SLE, the most frequent finding is pleural effusion, while in pSS, airway disease and parenchymal disorders prevail. In both cases, there is an increased risk of pre-capillary and post-capillary pulmonary arterial hypertension (PAH) and pulmonary venous thromboembolism (VTE). The risk of VTE is in part due to an increased thrombophilic status secondary to systemic inflammation or to the well-established association with antiphospholipid antibody syndrome (APS). The lung can also be the site of an organ-specific complication due to the aberrant pathologic immune-hyperactivation as occurs in the development of lymphoma or amyloidosis in pSS. Respiratory infections are a major issue to be addressed when approaching the differential diagnosis, and their exclusion is required to safely start an immunosuppressive therapy. Treatment strategy is mainly based on glucocorticoids (GCs) and immunosuppressants, with a variable response according to the primary pathologic process. Anticoagulation is recommended in case of VTE and multi-targeted treatment regimens including different drugs are the mainstay for PAH management. Antibiotics and respiratory physiotherapy can be considered relevant complement therapeutic measures. In this article, we reviewed lung manifestations in SLE and pSS with the aim to provide a comprehensive overview of their diagnosis and management to physicians taking care of patients with connective tissue diseases.
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Affiliation(s)
- Roberto Depascale
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giulia Del Frate
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Michela Gasparotto
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Valeria Manfrè
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Luca Quartuccio
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
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Lat T, Sanchez JF, McGraw MK, Hodjat P, White HD, Boethel CD. Decision-making in diagnosis of bronchus-associated lymphoid tissue lymphoma. Proc (Bayl Univ Med Cent) 2021; 34:451-455. [PMID: 34219924 DOI: 10.1080/08998280.2021.1889275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Bronchus-associated lymphoid tissue (BALT) lymphomas of the lung are uncommon, and diagnosis is often delayed due to the indolent clinical course. Often, adequate samples are difficult to obtain by bronchoscopy with transbronchial biopsy alone. This retrospective study reviewed the diagnosis and treatment of BALT lymphoma cases at our institution over the course of 19 years. Most patients were white, women, and >50 years old; the mean Charlson Comorbidity Index at the time of diagnosis was 6. Seven of 12 patients presented with solitary nodules or multiple nodules. For six cases, initial modalities were nondiagnostic; four subsequently underwent surgical biopsy, one underwent computed tomography-guided biopsy, and one underwent navigational bronchoscopy for final diagnosis of BALT lymphoma. Ultimately, 55% of cases were diagnosed with nonsurgical biopsy. One patient suffered a pneumothorax related to the initial diagnostic attempt. Ten patients received chemotherapy, radiation, and/or surgery, and 11 of the 12 are still alive. Our data confirm the previously described indolent behavior of BALT lymphomas and the challenges related to diagnosis. While previous studies have suggested surgical biopsy as the primary modality for obtaining histopathology, navigational bronchoscopy could serve as a safer alternative.
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Affiliation(s)
- Tasnim Lat
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
| | - Juan F Sanchez
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
| | - Meghan K McGraw
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
| | - Parsa Hodjat
- Department of Pathology, Baylor Scott & White Health, Temple, Texas
| | - Heath D White
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
| | - Carl D Boethel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
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15
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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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16
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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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17
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Guan C, Shi Y, Liu J, Yang Y, Zhang Q, Lu Z, Zheng G, Ye W, Xue M, Zhou X, Zhang N, Li H, Xie R, Chen B, Lu P. Pulmonary involvement in acquired immunodeficiency syndrome-associated Kaposi's sarcoma: a descriptive analysis of thin-section manifestations in 29 patients. Quant Imaging Med Surg 2021; 11:714-724. [PMID: 33532271 DOI: 10.21037/qims-20-284] [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] [Indexed: 12/12/2022]
Abstract
Background Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (AIDS-KS) was the first malignant neoplasm to be described as being related to AIDS. The lungs are the most common visceral site of AIDS-KS. This study aimed to analyze the computed tomography (CT) manifestations of pulmonary involvement in AIDS-KS. Methods Twenty-nine male patients were enrolled in this retrospective study. Imaging evaluation parameters included lesion distribution, the flame sign, interlobular septal thickening, peribronchovascular interstitium thickening, ground-glass opacity (GGO), dilated blood vessels in lesions, and pleural effusion. Results A peribronchovascular distribution was observed in all patients, predominantly in the lower lobes. Of the patients, 58.62% (17/29) exhibited the flame sign, 75.86% (22/29) had interlobular septal thickening, 72.41% (21/29) had peribronchovascular interstitium thickening, 82.76% (24/29) had GGO, and 34.48% (10/29) had pleural effusion. Enlarged lymph nodes with a short-axis diameter >1.0 cm were found in 41.38% (12/29) of the patients. Of the 12 patients who underwent contrast-enhanced CT (CECT), 90.91% (11/12) had dilated blood vessels, and nodules, consolidations, and lymph nodes were observed to be strongly enhanced. Intrapulmonary lesions decreased in size or number after appropriate treatment during follow-up. Conclusions Common CT manifestations of pulmonary AIDS-KS include the flame sign, peribronchovascular distribution, peribronchovascular interstitium thickening, interlobular septa thickening, GGO, dilated blood vessel, and strong enhancement of nodules, consolidations, and lymph nodes. It is helpful to follow up the therapeutic effect of pulmonary AIDS-KS by chest CT.
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Affiliation(s)
- Chunshuang Guan
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jinxin Liu
- Department of Radiology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuxin Yang
- Department of Radiology, The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qianqian Zhang
- Department of Radiology, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiyan Lu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guangping Zheng
- Department of Radiology, The Shenzhen No. 3 People's Hospital, Guangdong Medical College, Shenzhen, China
| | - Wen Ye
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Ming Xue
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xingang Zhou
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Na Zhang
- Department of Radiology, Chengdu Public Health Clinical Center, Chengdu, China
| | - Hongjun Li
- Department of Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Ruming Xie
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Budong Chen
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Puxuan Lu
- Department of Radiology, Shenzhen Center for Chronic Disease Control, Shenzhen, China
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18
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Sanguedolce F, Zanelli M, Zizzo M, Bisagni A, Soriano A, Cocco G, Palicelli A, Santandrea G, Caprera C, Corsi M, Cerrone G, Sciaccotta R, Martino G, Ricci L, Sollitto F, Loizzi D, Ascani S. Primary Pulmonary B-Cell Lymphoma: A Review and Update. Cancers (Basel) 2021; 13:cancers13030415. [PMID: 33499258 PMCID: PMC7865219 DOI: 10.3390/cancers13030415] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The group of B-cell lymphomas primarily involving the lung encompasses different histological entities with distinct biological aspects, while sharing some clinical and radiological features related to their common anatomic site of occurrence. Recent molecular advances in the molecular genetics of these lesions have substantially improved of our understanding of the mechanisms of lymphomagenesis, adding novel information to histology in order to better characterize and manage these diseases. This review summarizes the available clinical, radiological, pathological, and molecular data on primary pulmonary B-cell lymphomas, discusses the mechanisms of lymphomagenesis, and highlights the role of a multi-disciplinary management in overcoming the diagnostic and therapeutic challenges in this setting. Abstract Primary pulmonary B-cell lymphomas (PP-BCLs) comprise a group of extranodal non-Hodgkin lymphomas of B-cell origin, which primarily affect the lung without evidence of extrapulmonary disease at the time of diagnosis and up to 3 months afterwards. Primary lymphoid proliferations of the lung are most often of B-cell lineage, and include three major entities with different clinical, morphological, and molecular features: primary pulmonary marginal zone lymphoma of mucosa-associated lymphoid tissue (PP-MZL, or MALT lymphoma), primary pulmonary diffuse large B cell lymphoma (PP-DLBCL), and lymphomatoid granulomatosis (LYG). Less common entities include primary effusion B-cell lymphoma (PEL) and intravascular large B cell lymphoma (IVLBCL). A proper workup requires a multidisciplinary approach, including radiologists, pneumologists, thoracic surgeons, pathologists, hemato-oncologists, and radiation oncologists, in order to achieve a correct diagnosis and risk assessment. Aim of this review is to analyze and outline the clinical and pathological features of the most frequent PP-BCLs, and to critically analyze the major issues in their diagnosis and management.
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Affiliation(s)
- Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, Italy
- Correspondence: ; Tel.: +39-0881-736315
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Alessandra Soriano
- Gastroenterology, Division and Inflammatory Bowel Disease Center, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Giorgia Cocco
- Radiotherapy Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, Italy;
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Giacomo Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Matteo Corsi
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Giulia Cerrone
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Raffaele Sciaccotta
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Linda Ricci
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Francesco Sollitto
- Institute of Thoracic Surgery, University of Foggia, 71122 Foggia, Italy; (F.S.); (D.L.)
| | - Domenico Loizzi
- Institute of Thoracic Surgery, University of Foggia, 71122 Foggia, Italy; (F.S.); (D.L.)
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
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Casal Moura M, Navin PJ, Johnson GB, Hartman TE, Baqir M, Yi ES, Ryu JH. Pulmonary nodules in patients with primary Sjögren's syndrome: Causes, clinico-radiologic features, and outcomes. Respir Med 2020; 174:106200. [PMID: 33147563 DOI: 10.1016/j.rmed.2020.106200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary Sjögren's Syndrome (pSS) is characterized by an immune-mediated lymphoplasmacytic infiltration of the salivary and lacrimal glands. Pulmonary nodules are not uncommonly encountered in these patients. METHODS We conducted a retrospective computer-assisted search for patients with pSS who were encountered at our institution between 1999 and 2018 and had histologically characterized pulmonary nodule(s)/mass (es) (PNs). RESULTS Of 41 patients with pSS and PNs, median age was 67 years (IQR, 56-74), 94% were women, and 39% had a smoking history. The PNs proved to be non-Hodgkin lymphoma (NHL) in 16 patients (39%), lung carcinoma in 11 patients (27%), other malignancies in 2 patients (5%), and benign diseases in remaining 12 patients (29%), including 7 with amyloidomas. Patients with NHL were younger (p = 0.006) while smoking exposure was more prevalent in patients with lung carcinoma (p = 0.022). Patients with NHL had a higher number of PNs and more often manifested random distribution, cysts, ground-glass changes and consolidations. Upper and/or mid-lung location, spiculated borders, solitary nodule, increasing size, and higher SUVmean on FDG-PET scan were associated with lung carcinoma. At the end of follow-up (median 5.9 years), 8 patients (20%) had died and included 5 patients with lung carcinoma; no deaths were observed in the NHL group. CONCLUSIONS The majority of biopsied PNs in patients with pSS were malignant, most commonly lymphomas. Smoking exposure, solitary nodule, and high FDG avidity were more frequently associated with lung carcinoma. The clinical context, CT and 18FDG-PET are complementary in the evaluation and management of PNs in patients with pSS.
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Affiliation(s)
- M Casal Moura
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Patrick J Navin
- Division of Nuclear Medicine, Department of Radiology, and Department of Immunology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, and Department of Immunology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Thomas E Hartman
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eunhee S Yi
- Dvision of Anatomic Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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20
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Wang Y, Han J, Zhang F, Wang Z, Zhao D, Wang X, Wu N, Lu R, Wu C, Gao J, Pan L, Xue X. Comparison of radiologic characteristics and pathological presentations of primary pulmonary lymphoma in 22 patients. J Int Med Res 2020; 48:300060519879854. [PMID: 31880183 PMCID: PMC7607049 DOI: 10.1177/0300060519879854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was performed to compare the radiologic characteristics and pathological presentations of primary pulmonary lymphoma (PPL), explore the possible mechanism underlying its development, summarize its radiologic characteristics, and improve the accuracy of its diagnosis. METHODS The medical records of 22 patients pathologically diagnosed with PPL were retrospectively analyzed. RESULTS Chest computed tomography (CT) demonstrated single or multiple nodules and masses in the lungs, patchy opacities or consolidation along the bronchovascular bundle, and no significantly enlarged mediastinal or hilar lymph nodes. All 22 cases of PPL were classified as non-Hodgkin's lymphoma (NHL) by transbronchial biopsy, CT-guided needle biopsy, and postoperative pathology. Most (16 cases) were marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT). Twelve patients had air bronchograms within the lesion, and 13 showed ill-defined lesions with ground-glass brush-like changes. CONCLUSION PPL is a rare lung tumor, and most are classified as MALT lymphoma, a subtype of NHL. Chest CT can help to diagnose this disease. Positron emission tomography (PET)/CT is of great clinical value for evaluation of the lesion and patient's general condition. The possibility of PPL should be considered in patients with characteristic CT and PET/CT findings and mild clinical symptoms, and early treatment should be administered.
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Affiliation(s)
- Yanchao Wang
- Department of CT/MRI Center, People’s Hospital of Wuwei city, Gansu, China
| | - Jun Han
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fantao Zhang
- Department of Radiology, Shengli Oilfield Central Hospital of Dongying city, Shandong, China
| | - Zhaoyu Wang
- Department of Pathology, Zhoushan Hospital, Zhejiang, China
| | - Dahai Zhao
- Department of Respiratory Medicine, The Second Hospital of Anhui Medical University, Anhui, China
| | - Xuan Wang
- Department of Psychiatry, Beijing Huilongguan Hospital, Beijing, China
| | - Ningxin Wu
- Department of Cadres, 971 Hospital of the Chinese People’s Liberation Army Navy, Beijing, China
| | - Rongjian Lu
- Department of Stomatology, Chinese PLA 307th Hospital, Beijing, China
| | - Chongchong Wu
- Department of Radiology, General Hospital of PLA, Beijing, China
| | - Jie Gao
- Department of Pathology, General Hospital of PLA, Beijing, China
| | - Lei Pan
- Department of Respiratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xinying Xue
- Department of Respiratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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21
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Xie X, Zhang L, Wu M, Kang Z, Yan H, Zhang X, Shen W, Dong M. A retrospective study on the clinical characteristics and radiological features of primary pulmonary lymphoma. Transl Cancer Res 2020; 9:1969-1977. [PMID: 35117543 PMCID: PMC8798910 DOI: 10.21037/tcr.2020.02.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/04/2020] [Indexed: 12/20/2022]
Abstract
Background The retrospective study was mainly performed to determine the clinical symptoms and radiological characteristics of primary pulmonary lymphoma (PPL) to improve the recognition and diagnosis of the disease. Methods Between June 2007 and June 2019, the clinical data and radiological images of the 16 patients with PPL confirmed by pathology were retrospectively analyzed. Results Among the 16 patients with PPL (6 males and 10 females, aged 32 to 72 years, with a median age of 55.13 years), 9 patients were mucosa-associated lymphoid tissue lymphoma (MALT) and 7 patients were diffuse large B-cell lymphoma (DLBCL); all of the patients did not suffer from autoimmune disease [such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or Sjogren’s syndrome (SSS)]; and 11 patients had a long-term smoking history from 10 to 40 years. The common clinical symptoms were as follows: chest discomfort (n=8), cough (n=10), chest pain (n=7), fever (n=6), apnea (n=1), fatigue (n=4) and weight loss (n=3), however, 6 cases did not show clear symptoms at the time of diagnosis. Blood tests revealed anemia (n=6), thrombocytopenia (n=2), lactate dehydrogenase (LDH) level (n=7), C-reactive protein (CRP) (n=9), erythrocyte sedimentation rate (ESR) (n=8) and no tumor-related indexes were detected abnormal. The chest radiological images showed a total of 8 cases with multiple masses, 2 cases with different types of nodes, 4 cases with patchy infiltration or consolidation shadow, with or without an air bronchogram, and 2 cases with a mixed manifestation. All the lesions were only involved in unilateral lung (13 right, 3 left), none of them located on bilateral lung fields. At the time of admission, the patients were misdiagnosed as lung cancer (n=9), pneumonia (n=5), tuberculosis (n=1), and diffuse interstitial lung disease (n=1). Then final pathological diagnosis was confirmed by surgery (n=9), percutaneous lung biopsy (n=5), and bronchoscopic biopsy (n=2). Conclusions PPL is a rare disease, though clinical symptoms and radiological characteristics are not typical, they serve as significant clues for the diagnosis and differential diagnosis. Accurate diagnosis mainly depends on histopathological examination, however, conducting a retrospectively study could improve and enrich our knowledge to the disease and reduce inappropriate treatments.
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Affiliation(s)
- Xiaodong Xie
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
| | - Lei Zhang
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
| | - Mengjie Wu
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
| | - Zheng Kang
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
| | - Hongwei Yan
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
| | - Xiuming Zhang
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
| | - Wenrong Shen
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
| | - Min Dong
- Departments of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210000, China
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Cozzi D, Dini C, Mungai F, Puccini B, Rigacci L, Miele V. Primary pulmonary lymphoma: imaging findings in 30 cases. Radiol Med 2019; 124:1262-1269. [PMID: 31583557 DOI: 10.1007/s11547-019-01091-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To present our experience of cases of primary pulmonary lymphoma (PPL) found between January 2002 and July 2018, focusing on the radiological features and the differential diagnosis in order to contribute to the difficult role of the radiologist in the disease identification and to help the clinicians to reach the diagnosis. MATERIALS AND METHODS CT scans of 30 patients (14 men and 16 women, aged 58-86, mean age 72 years) with PPL were retrospectively reviewed. All patients had a histopathological confirmation of the disease: MALT lymphoma (23 patients, 76.6%); diffuse large B-cell lymphoma-DLBCL (seven patients, 23.4%). All the staging CT scans were evaluated by three experienced radiologists dedicated to thoracic disease in order to radiologically define the predominant pattern of presentation. RESULTS The following parenchymal patterns were observed: 11 patients with single/multiple nodules, five with masses/mass-like consolidations, 14 with consolidations with air bronchogram, 16 with ground-glass opacity, ten with angiogram sign, 22 with perilymphatic and/or peribronchovascular spread, 15 with associated lymphadenopathies, and 13 with pleural/chest wall involvement. The main characteristics of PPLs were the presence of consolidations and ground-glass opacities, with perilymphatic and/or bronchovascular spread. CONCLUSION All the characteristics of the work should alert the radiologist to consider lymphoma among the possible differential diagnoses, always correlating the results of the CT examination with appropriate clinical laboratory evaluations.
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Affiliation(s)
- Diletta Cozzi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Catia Dini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Francesco Mungai
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Benedetta Puccini
- Haematology Unit - Department of Oncology, University Hospital Careggi, Florence, Italy
| | - Luigi Rigacci
- Haematology Unit and Bone Marrow Transplant Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy.
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23
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Patel S, Nasser W, Khan R, Herrera L. Bilateral pulmonary nodules in a patient with extensive autoimmune disease. Thorax 2019; 74:1089-1090. [PMID: 31383775 DOI: 10.1136/thoraxjnl-2019-213632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Sachin Patel
- Pulmonary/Critical Care & Sleep Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Wael Nasser
- Pulmonary/Critical Care & Sleep Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Rumi Khan
- Pulmonary/Critical Care & Sleep Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Luis Herrera
- Thoracic Surgery, Orlando Regional Medical Center, Orlando, Florida, USA.,Department of Thoracic Surgery, UF Health Cancer Center-Orlando Health, Orlando, Florida, USA
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Abstract
Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is the most common primary pulmonary lymphoma. There are limited studies on imaging features of pulmonary MALT lymphoma. We present the computed tomography (CT) manifestations of pulmonary MALT lymphoma and the correlation between CT manifestations and clinical characteristics. Patients (n = 53) with histologically confirmed pulmonary MALT lymphoma who underwent chest CT scanning were retrospectively analyzed. Evaluated findings included distribution of pulmonary lesions, morphological pattern of appearance, contrast enhancement features, size, presence of thoracic lymphadenopathy, and secondary associated features. Pulmonary MALT lymphoma was observed in multiple (79%) and bilateral (66%) disease with random distribution (≥70%) of pulmonary lesions. The most frequent morphological pattern was consolidation (n = 33, 62%), followed by nodule (n = 23, 43%) and mass (n = 11, 21%). Common associated features were air bronchograms and bronchiectasis, especially cystic bronchiectasis and angiogram sign. Asymptomatic patients had less consolidation and bronchiectasis than did symptomatic patients. Cystic bronchiectasis was only observed in the symptomatic group. In conclusion, pulmonary MALT lymphoma manifests as diverse patterns on CT scans. Consolidation combined with cystic bronchiectasis was a characteristic late sign, which may assist in differential diagnosis. High-resolution CT images and multiplanar reconstruction techniques are helpful for accurately determining imaging manifestations.
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25
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Clinical features and outcomes of pulmonary lymphoma: A single center experience of 180 cases. Lung Cancer 2019; 132:39-44. [PMID: 31097092 DOI: 10.1016/j.lungcan.2019.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pulmonary lymphoma arises primarily from the lung, which is extremely rare, or be secondarily involved by lymphoma. The clinical features, management, and prognostic factors have not been clearly identified. METHODS Sixty-three patients with primary pulmonary lymphoma (PPL) and 117 patients with secondary pulmonary lymphoma (SPL) treated in our institution between June 2003 and December 2017 were retrospectively reviewed. RESULTS MALT (67%) was the most common pathological subtype of PPL, while DLBCL (48%) was the most common subtype of SPL. Compared to the patients with PPL, the presence of B symptoms, advanced disease stage, intermediate-high or high risks of IPI and NCCN-IPI, elevated inflammatory parameters, and elevated cytokine levels were all observed in patients with SPL. Consolidation was the most frequent radiological finding in PPL cases, while nodules were the most frequent finding in SPL. With a median follow-up of 35 months (range 2-176), the estimated 3-year OS rates were 95%, 100%, 70% and 50% in indolent PPL, indolent SPL, aggressive PPL, and aggressive SPL, respectively. In indolent pulmonary lymphoma, none of the prognostic factors we studied significantly influenced survival of the patients. In aggressive pulmonary lymphoma, univariate analysis showed that NCCN-IPI was related to OS in PPL. Multivariate analysis showed that β2-MG was an independent prognostic factor for OS in SPL. CONCLUSIONS Primary and secondary pulmonary lymphoma differ in their clinical features and outcome. Furthermore, β2-MG is the independent prognostic factor for OS in patients with aggressive SPL.
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26
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Uptake of [ 18F]fluorodeoxyglucose in initial positron-emission tomography predicts survival in MALT lymphoma. Blood Adv 2019; 2:649-655. [PMID: 29563121 DOI: 10.1182/bloodadvances.2017013698] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/16/2018] [Indexed: 12/27/2022] Open
Abstract
The role of [18F]fluorodeoxyglucose (FDG) positron-emission tomography (PET) in mucosa-associated lymphoid tissue (MALT) of marginal zone lymphoma remains poorly defined. We correlated initial PET with pathology, clinical factors, and outcome. From January 2001 to July 2012, 173 MALT lymphoma patients with a biopsied lesion identified on PET within 90 days of tissue biopsy were analyzed. PET positivity and intensity of FDG uptake were correlated with clinical factors and patient outcome. Among 173 accrued cases, biopsied site was PET avid in 123 patients (71%); median standardized uptake value (SUV) was 6.0 (range: 0.7-28.0), and SUV >10.0 in 20 patients (16%). PET avidity varied by organ sites. PET positivity correlated with higher International Prognostic Index, but not with 5-year overall survival (OS; 96% vs 88%, PET negative vs positive, P = .229) or 5-year progression-free survival (67% vs 56%, P = .493). SUV was an independent prognostic factor of OS, and an increased SUV was associated with a decreasing 5-year OS. Patients who presented with SUV ≥10 had a higher rate of subsequent large cell transformation (20% vs 5%, P = .035) and inferior OS (78% vs 92%, P = .008). The exact role of FDG PET in the management of MALT lymphoma, beyond initial staging, remains to be defined.
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27
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Marchiori E, Hochhegger B, Zanetti G. Dilated Air Bronchogram Inside Areas of Consolidation: A Tomographic Finding Suggestive of Pulmonary Lymphoma. Arch Bronconeumol 2018; 55:383-384. [PMID: 30606629 DOI: 10.1016/j.arbres.2018.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/05/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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28
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Chen Y, Chen A, Jiang H, Zhang Y, Zhu L, Xia C, Yu H. HRCT in primary pulmonary lymphoma: can CT imaging phenotypes differentiate histological subtypes between mucosa-associated lymphoid tissue (MALT) lymphoma and non-MALT lymphoma? J Thorac Dis 2018; 10:6040-6049. [PMID: 30622775 DOI: 10.21037/jtd.2018.10.63] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Primary pulmonary lymphoma (PPL) mainly comprises mucosa-associated lymphoid tissue (MALT) lymphoma as well as other subtypes of lymphoma. Different phenotypes of PPL demonstrate various high-resolution computed tomography (HRCT) features. We aimed to evaluate the value of HRCT in the diagnosis and differential diagnosis of PPL, especially between MALT lymphoma and non-MALT lymphoma and the correlation between CT and pathological features. Methods We performed a retrospective analysis on 72 patients with PPL confirmed by pathology between 2007 and 2016. We compared the CT characteristics and correlation with pathological findings between MALT lymphoma and non-MALT lymphoma groups. Results All 72 patients with PPL were classified into two groups: low-grade MALT lymphoma (MALToma) (56/72) and high-grade non-MALT lymphoma (non-MALToma) (16/72). The latter group consisted of diffuse large B cell lymphoma (8/72), Hodgkin's lymphoma (3/72), T-cell lymphoma (4/72), and intravascular large B-cell lymphoma (1/72). A total of 168 lesions were analyzed, including 57 cases with multiple lesions and 15 cases with single lesion. The manifestation of four distribution patterns: nodular or mass-like involvement pattern, diffuse interstitial lung disease (DILD) pattern, pneumonia-like consolidative pattern and mixed pattern was not significantly different between MALToma and non-MALToma (all P>0.05). Signs of air bronchogram and CT angiogram occurred significantly more often in individuals with MALToma group than those with non-MALToma (75% vs. 25%, P=0.001; 64.3% vs. 12.5%, P<0.001; respectively). Conversely, the halo sign presented more often in non-MALToma than in MALToma patients (19% vs. 63.6%, P=0.02). In addition, the butterfly sign was only observed in four patients with MALToma. Conclusions HRCT imaging phenotypes were beneficial in the diagnosis of PPL. Solitary or multifocal nodules/masses and consolidation were the most common imaging patterns. The air bronchogram sign, CT angiogram sign, halo sign, and butterfly sign could be potential to help to differentiate MALToma from non-MALToma.
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Affiliation(s)
- Yinan Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Aiping Chen
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hailin Jiang
- Department of Interventional Radiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Yuxuan Zhang
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, Belfast, UK
| | - Lin Zhu
- Department of Imaging and Nuclear Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Chunyan Xia
- Department of Pathology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Hong Yu
- Department of Radiology, Shanghai Oriental Hospital Affiliated Tongji University, Shanghai 200120, China
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29
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Huang N, Wei ML, Wang B, Zhang CL, Li WC. A case report of unusual cavity presentation of pulmonary extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. Medicine (Baltimore) 2018; 97:e11372. [PMID: 29979424 PMCID: PMC6076019 DOI: 10.1097/md.0000000000011372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The common CT scan findings of pulmonary MZBL of MALT type include airspace consolidation, nodules and ground-glass opacity. But, to our knowledge, the present case is the first report of a cavity presentation of pulmonary MZBL of MALT type. PATIENT CONCERNS The patient gives his consent and authorizes the photographs featuring his likeness to be published. DIAGNOSES This patient was diagnosed as pulmonary MZBL of MALT type by pathology, immunohistochemistry, and gene rearrangement. INTERVENTIONS The patient was treated with CHOP (cyclophosphamide, adriamycin, vincristine and prednisone) chemotherapy for twice and antibiotics. OUTCOMES He is being followed up for one year, with slight progress in pulmonary MZBL of MALT. LESSONS This case highlights the need to be suspicious of MZBL of MALT type, when a radiographic image shows cavity lesion. We should consider whether the diagnosis is correct, when the patient's treatment is not effective.
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30
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De Vega Sanchez B, Disdier Vicente C, Lopez Pedreira MR. An asymptomatic man with pathological chest radiography. Breathe (Sheff) 2018; 13:e103-e108. [PMID: 29928458 PMCID: PMC6003270 DOI: 10.1183/20734735.008717] [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] [Indexed: 11/12/2022] Open
Abstract
A 76-year-old, male, ex-smoker (40 pack-years) was referred to our outpatient clinic for progressive dyspnoea (grade II–III/IV on the Medical Research Council scale [1]) over the last 20 years. Can you diagnose this patient whose symptoms belie his radiographic pathology?
http://ow.ly/Xuip30dGShQ
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Affiliation(s)
| | - Carlos Disdier Vicente
- Respiratory Medicine Dept, Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBERES (Centro de Investigación en Red Enfermedades Respiratorias), Spain
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31
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Abstract
A 57-year-old man had a diagnosis of a bronchial mucosa-associated lymphoid tissue lymphoma in the left lung and monoclonal gammopathy. The patient underwent whole-body C-methionine PET/CT, in order to evaluate the amino acid avidity of the lesion and to stage the bronchial mucosa-associated lymphoid tissue lymphoma. C-methionine uptake was detected in the lung lesion and in the mediastinal lymph nodes.
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32
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Yao D, Zhang L, Wu PL, Gu XL, Chen YF, Wang LX, Huang XY. Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study. BMC Cancer 2018. [PMID: 29530011 PMCID: PMC5848441 DOI: 10.1186/s12885-018-4184-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The primary pulmonary lymphoma (PPL), with a low incidence, was highly misdiagnosed in clinic. The present study analyzes the clinical features, laboratory and imaging data, pathologic characteristics, and summarizes misdiagnosis reasons of PPL cases, aims to provide a better understanding and increase the accuracy of early diagnosis and minimize the misdiagnosis of PPL. Methods The clinical data of 19 cases were collected from the first affiliated hospital of Wenzhou medical university (PRC) from April 2010 to May 2016. All cases were confirmed by pathology. The process of misdiagnosis was described. This study retrospectively analyzed the incidence, clinical presentation, laboratory examination, Chest CT scan and diagnosis of the cases. Results The symptoms of the 19 cases were dyspnea, fever, hemoptysis, chest pain or physical findings without obvious symptoms. Five patients were pneumonia-like, nine patients had lung single nodule or mass and four patients got pleural effusion, which were reported by computed tomography (HRCT) scan. There were 2 cases of Hodgkin lymphoma (HL), and 17 cases of non-Hodgkin lymphoma (NHL). In NHL cases, 12 cases were confirmed mucosa associated lymphoid tissue B lymphoma type, 3 cases were confirmed diffuse large B-cell lymphoma, angioimmunoblastic T-cell lymphoma and ALK positive anaplastic large cell lymphoma were one case separately. Clinical and imaging manifestation of PPL is untypical, but there are still some hints: 1) Fuzzy shadow at the edge of lung mass with air bronchogram; 2) Lung mass shadow stable for a long time; 3) Pneumonia-like changing without infections clinical and lab manifestation. Thirteen patients (68.4%) were misdiagnosed as pneumonia, lung cancer and tuberculosis initially. The term between initial diagnosis and final diagnosis lasted for half a month up to 2 years, with median time of 6 months. Two cases were misdiagnosed as tuberculosis. One case was misdiagnosed as small cell lung cancer. Conclusion Clinical and imaging manifestation of PPL is untypical. Biopsies should be taken actively if the imaging findings don’t match the symptoms or the anti-infection treatments to “lung infection” don’t work. Accurate diagnosis requires adequate tissue sampling with appropriate ancillary pathologic studies. If clinical manifestation and the diagnosis don’t match, repeated biopsy should be ordered.
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Affiliation(s)
- D Yao
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - L Zhang
- Wenzhou Medical University, Zhejiang, 325035, China
| | - P L Wu
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - X L Gu
- Wenzhou Medical University, Zhejiang, 325035, China
| | - Y F Chen
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - L X Wang
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China
| | - X Y Huang
- The First Affiliated Hospital of Wenzhou Medical University & Key Laboratory of Heart and Lung, Zhejiang, 325035, China.
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33
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Zhao S, Zhang L, Gu Z, Zhu C, Fang S, Yang N, Wang F, Guan L, Luo L, Gao C. Clinical manifestations of pulmonary mucosa-associated lymphoid tissue lymphoma: single-center experience with 18 patients. Onco Targets Ther 2018; 11:555-561. [PMID: 29416356 PMCID: PMC5790107 DOI: 10.2147/ott.s147275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare entity. To date, the optimal treatment for this disease is still under debate. The aim of this study was to analyze and summarize the clinical manifestations and therapeutic experience of 18 pulmonary MALT lymphoma patients to collect information about the optimal treatment modality. Patients and methods A retrospective analysis was performed in patients who were diagnosed with pulmonary MALT lymphoma at the Chinese People’s Liberation Army General Hospital from April 1995 to April 2016. Results Clinical data of 18 patients were available. The median age was 55 (range, 34–67) years. Also, 61.1% of the patients were male. Only 33.3% had a history of smoking and 27.8% of the patients had tuberculosis. Treatment modalities included surgery alone in 1 patient (5.6%), chemotherapy in 10 patients (55.5%), surgery in combination with chemotherapy in 6 patients (33.3%) and observation in 1 patient (5.6%). Over the median observation period of 93 months, 2 patients died, the median progression-free survival was 6 years, and the estimated 5- and 10-year overall survival rates were 94.1% and 83.7%, respectively. The survival data confirmed the indolent nature of the disease. There was no difference in progression-free survival between the chemotherapy group and the surgery in combination with chemotherapy group. Conclusion Pulmonary MALT lymphoma tended to be an indolent disease. In order to preserve the lung function and reduce the risks associated with surgery, chemotherapy might be an optimal choice for the treatment of pulmonary MALT lymphoma.
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Affiliation(s)
- Shasha Zhao
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing.,School of Medicine, Nankai University, Tianjin
| | - Lin Zhang
- Department of Hematology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Zhenyang Gu
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing
| | - Chengying Zhu
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing.,School of Medicine, Nankai University, Tianjin
| | - Shu Fang
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing
| | - Nan Yang
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing
| | - Feiyan Wang
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing.,School of Medicine, Nankai University, Tianjin
| | - Lixun Guan
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing
| | - Lan Luo
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing
| | - Chunji Gao
- Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing
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Albano D, Borghesi A, Bosio G, Bertoli M, Maroldi R, Giubbini R, Bertagna F. Pulmonary mucosa-associated lymphoid tissue lymphoma: 18F-FDG PET/CT and CT findings in 28 patients. Br J Radiol 2017; 90:20170311. [PMID: 28830222 DOI: 10.1259/bjr.20170311] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the CT and fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) imaging findings of lung mucosa associated lymphoid tissue (MALT) lymphoma. METHODS 28 patients with histologically confirmed pulmonary MALT lymphoma who underwent a chest CT and 18F-FDG PET/CT for staging were retrospectively analysed. The CT images were evaluated to determine morphological pattern of appearance, laterality, localization, number, size, presence of thoracic lymphadenopaties and secondary/combined findings. PET images were analysed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio and lesion-to-blood pool SUVmax ratio. The relationship between qualitative and semi-quantitative features at 18F-FDG PET/CT and CT findings were also analysed. RESULTS A total of 57 pulmonary lesions were identified by CT: 37 areas of consolidation, 4 masses, 12 nodules and 4 ground-glass opacities. Solitary and multiple lesions were detected in 10 and 18 patients, respectively; among patients with multiple lesions, 16 were bilateral and 2 unilateral. 18F-FDG PET/CT revealed increased 18F-FDG uptake in 47/57 lesions, in 26/28 patients. 18F-FDG avidity was significantly associated only with tumour size. CONCLUSIONS Pulmonary MALT lymphoma is 18F-FDG avid in most cases and 18F-FDG avidity is correlated with tumour size. Consolidation is the most frequent morphological pattern of disease presentation. Advances in knowledge: This study demonstrated that lung MALT lymphoma are 18F-FDG avid in most cases depending on tumour size. Single or multiple areas of consolidation are the most common pattern of presentation of lung MALT lymphoma at CT.
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Affiliation(s)
| | - Andrea Borghesi
- 2 Department of Radiology, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Giovanni Bosio
- 1 Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | - Mattia Bertoli
- 1 Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | - Roberto Maroldi
- 2 Department of Radiology, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Raffaele Giubbini
- 3 Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- 3 Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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35
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Lee H, Yang B, Nam B, Jeong BH, Shin S, Zo JI, Shim YM, Kwon OJ, Lee KS, Kim H. Treatment outcomes in patients with extranodal marginal zone B-cell lymphoma of the lung. J Thorac Cardiovasc Surg 2017; 154:342-349. [PMID: 28457544 DOI: 10.1016/j.jtcvs.2017.03.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 02/10/2017] [Accepted: 03/05/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate clinical presentations, treatment modalities, and outcomes of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma by stage strata. METHODS We retrospectively reviewed 51 patients diagnosed with pulmonary MALT lymphoma between January 2003 and December 2015. To compare treatment modalities and outcomes, we stratified the patients into low-stage (IE/IIE) and high-stage (IIIE/IVE) groups using modified Ann Arbor staging. Progression-free survival was estimated using Kaplan-Meier curves, and differences were compared using the log-rank test. A hazard ratio of progression by stage strata, adjusted for other clinical variables, was determined using a Cox adjusted proportional hazards model. RESULTS The majority of patients had stage IE disease (76.5%; 39 of 51). With advancing stage, patients were more likely to have respiratory and B symptoms and higher International Prognostic Index scores. The most common treatment modality was surgical resection in low-stage patients (33 of 43) and chemotherapy in high-stage patients (7 of 8). At a median follow-up of 40.7 months, progression-free survival was longer for low-stage patients (median, 40.7 months vs 24.9 months; P < .001), and high-stage patients were 9.2 times more likely to progress (hazard ratio, 9.24; 95% confidence interval, 1.93-44.36). Among 30 patients with surgically resected stage IE disease, 8 with central lesions were treated via lobectomy and 22 with peripheral lesions were treated via lobectomy (n = 8) or limited resection (n = 14). One of these patients, with a central lesion, experienced disease recurrence. CONCLUSIONS Our findings suggest that the clinical course of low-stage pulmonary MALT lymphoma, for which the mainstay of treatment is surgical resection, might be indolent.
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Affiliation(s)
- Hyun Lee
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bumhee Yang
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boda Nam
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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36
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Extranodal Marginal Zone Endobronchial Lymphoma Associated With Hepatitis C. Ann Thorac Surg 2017; 102:e407-e408. [PMID: 27772593 DOI: 10.1016/j.athoracsur.2016.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 11/21/2022]
Abstract
We describe two patients with hepatitis C and a diagnosis of pulmonary extranodal marginal zone B cell lymphoma. Both patients demonstrated a chronic nonproductive cough without hemoptysis. Diagnosis was obtained after a computed tomographic chest scan and flexible bronchoscopic biopsy. We discuss the staging and prognosis of this disease, its correlation with hepatitis C, and potential benefits of treating the associated hepatitis C.
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37
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Abstract
Primary pulmonary lymphomas represent a pathologically heterogeneous group of disorders that often share imaging features, which include peribronchovascular nodules and masses or areas of nonresolving consolidation. Primary mediastinal B-cell lymphoma is an extranodal non-Hodgkin lymphoma seen in younger patients that has imaging and pathologic features that demonstrate some degree of overlap with Hodgkin lymphoma. Primary lymphomas of the pleural space are rare and associated with concomitant viral infections.
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38
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Shrestha B, Kim B, Huffstetler A. An unusual presentation of gastric mucosa-associated lymphoid tissue (MALT)-type lymphoma. J Community Hosp Intern Med Perspect 2016; 6:31707. [PMID: 27609718 PMCID: PMC5016814 DOI: 10.3402/jchimp.v6.31707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022] Open
Abstract
Mucosa-associated lymphoid tissue (MALT)-type lymphoma is a relatively rare disease; nevertheless, it is the third most common lymphoma type, accounting for 5–7% of all non-Hodgkin lymphomas. Case series and retrospective analysis published in the literature have suggested that extra gastrointestinal (GI) MALT-type lymphoma can occur simultaneously with MALT-type lymphoma involving the GI tract. We report the case of a healthy, 64-year-old Caucasian male who presented with progressive fatigue, non-productive cough, and worsening exertional shortness of breath for 3 months who was subsequently diagnosed with gastric extra-nodal marginal zone B-cell lymphoma or MALToma with simultaneous metastasis to the lung (bronchi) based on biopsy reports.
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Affiliation(s)
- Bikram Shrestha
- Department of Internal Medicine, Saint Agnes Hospital Center, Baltimore, MD, USA;
| | - Bernard Kim
- Department of Critical Care and Pulmonary Medicine, Saint Agnes Hospital Center, Baltimore, MD, USA
| | - Alison Huffstetler
- Department of Family Medicine, University of Virginia Health System, Charlottesville, VA, USA
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Liu Y, Tangsun Y, Xiao Y, Zhang D, Cao M. Pulmonary infiltration with eosinophilia complicated with mucosa-associated lymphoid tissue lymphoma: A case report. Oncol Lett 2016; 12:1818-1820. [PMID: 27588128 PMCID: PMC4998093 DOI: 10.3892/ol.2016.4841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 04/22/2016] [Indexed: 01/15/2023] Open
Abstract
Tissue eosinophilia is rarely observed in cases of non-Hodgkin's lymphoma of B cell origin. The present study describes a rare case of mucosa-associated lymphoid tissue (MALT) lymphoma, which was initially misdiagnosed as eosinophilic pneumonia. The initial diagnosis was formed based on the results of chest radiography, peripheral eosinophilia tests and bronchoalveolar lavage, and the clinical course of the patient. Following administration of methylprednisolone (40 mg/day) for 4 days and oral administration of prednisolone (30 mg/day), the clinical course rapidly improved and the eosinophil count immediately decreased a to normal level. However, abnormal shadows observed on computed tomography (CT) scans of the chest did not diminish. At 6 months after the initiation of treatment, CT-guided percutaneous lung biopsy was performed, and a final diagnosis of primary pulmonary mucosa-associated lymphoid tissue lymphoma was made based on immunohistochemical examination. Primary lung MALT lymphoma remains a rare entity, with an indolent course and a reasonably favorable prognosis, whose diagnosis may be challenging.
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Affiliation(s)
- Yin Liu
- Department of Respiratory Medicine, Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Yinyan Tangsun
- Department of Respiratory Medicine, Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Yonglong Xiao
- Department of Respiratory Medicine, Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Deping Zhang
- Department of Respiratory Medicine, Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Min Cao
- Department of Respiratory Medicine, Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
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40
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Early Bronchus-Associated Lymphoid Tissue Lymphoma Diagnosed with Immunoglobulin Heavy Chain Molecular Testing. Can Respir J 2016; 2016:7056035. [PMID: 27445561 PMCID: PMC4904558 DOI: 10.1155/2016/7056035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/03/2015] [Indexed: 12/02/2022] Open
Abstract
When extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT), a low grade B-cell lymphoma, arises in the lung it is referred to as bronchus-associated lymphoid tissue (BALT) lymphoma. We describe a patient with a history of Sjögren's syndrome and rheumatoid arthritis with dyspnea and imaging consistent with lymphoid interstitial pneumonia (LIP). However, while histology and immunohistochemistry lacked definitive features of a lymphoma, immunoglobulin heavy chain (IgH) polymerase chain reaction testing demonstrated B-cell monoclonality, consistent with an early BALT lymphoma.
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41
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Bilateral Bronchiectasis as a Presentation Form of Pulmonary Marginal Zone B-Cell Lymphoma of Bronchus Associated Lymphoid Tissue. Case Rep Oncol Med 2016; 2015:975786. [PMID: 26839723 PMCID: PMC4709615 DOI: 10.1155/2015/975786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 11/25/2022] Open
Abstract
The pulmonary marginal zone B-cell lymphoma of bronchus associated lymphoid tissue of the lung (BALT) is a rare illness that can remain without symptoms. Radiological findings of pulmonary lymphoma are heterogeneous. In literature, bronchiectasis is only described in one patient who also had besides adenomegalies. We reported on a 48-year-old female patient. She showed symptoms consistent with dyspnea with productive cough; there were crepitant sounds in the auscultation. Pulmonary functional test has shown a severe restrictive pattern with a low FVC and DLCO. CT scan showed bronchiectasis in the medium lobule without adenomegalies. Echocardiogram was normal, and the laboratory findings only showed leukocytosis. There were no findings in the bronchoscopy, but the lung biopsy showed a B-cell pulmonary lymphoma (positive to CD20 and CD79a in immunostaining). A wide variety of radiological manifestations has been previously described; however, we have presented this rare case, with bronchiectasis, as unique radiological finding.
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42
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Abramson JS, Ferry JA, Muse VV, Lanuti M. Extranodal Marginal Zone Lymphoma Presenting As Miliary Lung Disease. J Clin Oncol 2016; 34:e27-30. [PMID: 24912892 DOI: 10.1200/jco.2013.50.6501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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43
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Borie R, Wislez M, Antoine M, Copie-Bergman C, Thieblemont C, Cadranel J. Pulmonary mucosa-associated lymphoid tissue lymphoma revisited. Eur Respir J 2016; 47:1244-60. [PMID: 26797028 DOI: 10.1183/13993003.01701-2015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022]
Abstract
This general review sought to clarify the pathophysiological, diagnostic, prognostic, and therapeutic features of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma.MALT lymphoma is the most common pulmonary B-cell lymphoma, which usually occurs in the context of acquired MALT. The disease is slow-growing with an asymptomatic chronic alveolar opacity visible on radiography. Diagnosis requires tissue samples that should be retrieved using minimally invasive techniques, such as bronchoscopy or computed tomography-guided biopsies. The pathophysiology includes cytogenetic abnormalities and autoimmune diseases, whereas an association with a chronic pulmonary infection is still suspected but not yet demonstrated. Disease prognosis is typically excellent and the current available treatments are discussed in this review, including the decision not to treat, surgery, and single- or double-agent chemotherapy.
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Affiliation(s)
- Raphael Borie
- Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, AP-HP, Hôpital Bichat, Paris, France
| | - Marie Wislez
- Service de Pneumologie, Centre de compétences maladies pulmonaires rares, AP-HP, Hôpital Tenon, Paris, France GRC-THERANOSCAN, Université P&M Curie, Université Paris 6, Paris, France
| | - Martine Antoine
- GRC-THERANOSCAN, Université P&M Curie, Université Paris 6, Paris, France Service d'Anatomie pathologique, AP-HP, Hôpital Tenon, Paris, France
| | | | - Catherine Thieblemont
- Service d'Hémato-oncologie, AP-HP, Hôpital Saint-Louis, Université Diderot, Sorbonne Paris Cité, Paris, France
| | - Jacques Cadranel
- Service de Pneumologie, Centre de compétences maladies pulmonaires rares, AP-HP, Hôpital Tenon, Paris, France GRC-THERANOSCAN, Université P&M Curie, Université Paris 6, Paris, France
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45
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Abstract
Primary lung lymphoma (PLL) is a rare disease that comprises <0.5% of all primary lung tumors. It is defined as lymphoma confined to the lung with or without hilar lymph node involvement at the time of diagnosis or up to 3 months thereafter. Patients with PLL may be asymptomatic or manifest nonspecific clinical symptoms, for example, cough, chest pain, and dyspnea. Some individuals may be immunosupressed or have an autoimmune disorder. Radiologically, PLL can mimic pneumonia, lung carcinoma, or metastasis, and therefore, histologic confirmation is mandatory for definitive diagnosis. Primary lung marginal zone lymphoma of mucosa-associated lymphoid tissue type comprises 70% to 80% of cases. Less common B-cell lymphomas include diffuse large B-cell lymphoma, lymphomatoid granulomatosis (LyG), plasmacytoma, and other small lymphocytic lymphomas. PLLs of T-cell origin, largely represented by anaplastic large cell lymphoma, are extremely rare. LyG is an Epstein-Barr virus (EBV)-driven B-cell lymphoid neoplastic proliferation rich in T cells that produces vasculitis. The disease may present at different stages of progression. Differential diagnosis of PLL varies according to the lymphoma subtype: pulmonary mucosa-associated lymphoid tissue lymphoma should be distinguished from reactive inflammatory conditions, whereas high-grade lymphomas may resemble poorly differentiated lung carcinoma, metastatic disease, and other lymphomas. LyG can resemble inflammatory, infectious, and other lymphoid neoplastic processes. A panel of immunohistochemical markers, flow cytometry, and molecular methods are necessary to confirm the diagnosis in the majority of cases. In this article we review the clinical, radiologic, pathologic, and molecular characteristics of several B-cell and T-cell PLLs with exception of Hodgkin lymphoma and posttransplant lymphoproliferative disorder.
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46
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Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Hematologic neoplasms: Interpreting lung findings in chest computed tomography. RADIOLOGIA 2015. [PMCID: PMC7153726 DOI: 10.1016/j.rxeng.2015.09.001] [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] [Indexed: 11/21/2022]
Abstract
Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients.
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47
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Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Hematologic neoplasms: interpreting lung findings in chest computed tomography. RADIOLOGIA 2015; 57:455-70. [PMID: 26315258 PMCID: PMC7127573 DOI: 10.1016/j.rx.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/26/2015] [Accepted: 07/04/2015] [Indexed: 12/21/2022]
Abstract
La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos.
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Affiliation(s)
- P Calvillo Batllés
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España.
| | - J Carreres Polo
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - J Sanz Caballer
- Servicio de Hematología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - M Salavert Lletí
- Unidad de Enfermedades Infecciosas, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - L Compte Torrero
- Servicio de Neumología, Hospital Politècnic i Universitari La Fe, Valencia, España
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Satoh K, Morita T, Fumimoto S, Tsuji H, Ichihashi Y, Ochi K, Hanaoka N, Okada Y, Katsumata T. Rare Pulmonary Metastasis From Thyroid Mucosa-Associated Lymphoid Tissue Lymphoma. Ann Thorac Surg 2015; 100:700-2. [PMID: 26234841 DOI: 10.1016/j.athoracsur.2014.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/03/2014] [Accepted: 09/09/2014] [Indexed: 10/23/2022]
Abstract
Primary pulmonary lymphomas constitute up to 1% of all pulmonary malignancies. Patients with mucosa-associated lymphoid tissue (MALT) lymphoma represent approximately 90% of patients with primary pulmonary lymphoma. Most pulmonary MALT lymphomas are primary tumors. Pulmonary metastasis is extremely rare. A 65-year-old woman was diagnosed with a thyroid MALT lymphoma in 2008 and underwent total thyroidectomy, followed by chemotherapy. After 5 years of follow-up, she referred to our hospital with an abnormal shadow on a chest roentgenogram. She underwent video-assisted thoracoscopic surgery and was diagnosed with metastatic thyroid MALT lymphoma. Postoperatively, she was treated with chemotherapy, including rituximab, and is alive without recurrence.
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Affiliation(s)
- Kiyoshi Satoh
- Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan.
| | - Takuya Morita
- Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan
| | - Satoshi Fumimoto
- Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan
| | - Hiroyuki Tsuji
- Department of Respiratory Medicine, Osaka Medical College Hospital, Takatsuki, Japan
| | - Yoshio Ichihashi
- Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan
| | - Kaoru Ochi
- Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan
| | - Nobuharu Hanaoka
- Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan
| | - Yoshikatsu Okada
- Department of Pathology, Osaka Medical College Hospital, Takatsuki, Japan
| | - Takahiro Katsumata
- Department of Thoracic Surgery, Osaka Medical College Hospital, Takatsuki, Japan
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49
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Li H, Wang T, Wei X, Dang X. Marginal zone B-cell lymphoma of the pulmonary mucosa-associated lymphoid tissue: A case report. Oncol Lett 2015; 10:1731-1734. [PMID: 26622741 DOI: 10.3892/ol.2015.3375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 11/21/2014] [Indexed: 11/06/2022] Open
Abstract
Marginal zone B-cell lymphoma of the pulmonary mucosa-associated lymphoid tissue (pulmonary MALT-MZL) is a common type of primary pulmonary lymphoma, but is rare as a pulmonary malignant tumor. In the present study, a 49-year-old male patient was admitted to The First Affiliated Hospital of Xi'an JiaTong University (Xi'an, China) with a pulmonary lesion in the right upper lung. The patient was diagnosed with pulmonary MALT-MZL subsequent to undergoing chest computed tomography (CT), a routine blood test, pathological and histological examinations, a transbronchial lung biopsy and bronchoscopy. A chest CT scan revealed right middle lobe consolidation and inflammatory signs, accompanied by mediastinal lymphadenopathy in the anterior basal segment of the upper lobe and CT angiogram signs. Bronchial stenosis and swollen mucosa were observed by bronchoscopy. The tissue section of the transbronchial lung biopsy specimens revealed diffusely infiltrated monocytoid B-cell lymphocytes and a lymphoepithelial lesion. The tissue was found to be positive for cluster of differentiation (CD)20, B-cell lymphoma 2 and CD79a expression, but negative for CD3, CD5, cyclin D1 and κ-light chain expression. CD21 and CD23, located in the residual follicular dendritic cells, were detected by immunohistochemical staining. The clinical manifestations of pulmonary MALT-MZL are non-specific and misdiagnosis frequently occurs in clinical practice. Therefore, an appropriate invasive biopsy procedure is necessary for early and accurate diagnosis of pulmonary MALT-MZL. Clinical presentation that includes periodic fever and distended bronchi in pulmonary consolidation may indicate a diagnosis of MALT-MZL. Pulmonary MALT-MZL belongs to the category of indolent lymphoma and accurate clinical diagnosis is challenging. The results in the present study may provide additional evidence for the accurate diagnosis of this rare entity.
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Affiliation(s)
- Hong Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaohong Wei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaomin Dang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shaanxi 710061, P.R. China
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50
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BI LINTAO, LI JUN, DAN WANG, LU ZHENXIA. Pulmonary MALT lymphoma: A case report and review of the literature. Exp Ther Med 2015; 9:147-150. [PMID: 25452791 PMCID: PMC4247291 DOI: 10.3892/etm.2014.2072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal low-grade B-cell lymphoma. Pulmonary MALT lymphoma is considered to originate from bronchial MALT and is also referred to as bronchial-associated lymphoid tissue lymphoma. Pulmonary MALT lymphoma is a rare disease, but it is the most frequent subset of primary pulmonary lymphoma. The median age at diagnosis of pulmonary MALT lymphoma is 50-60 years, with only few patients aged <30 years. This is the case report of a 19-year-old patient with pulmonary MALT lymphoma presenting with a multiple pulmonary consolidation pattern on computed tomography scans, who underwent successful chemotherapeutic treatment with a chlorambucil-based regimen.
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Affiliation(s)
- LINTAO BI
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
| | - JUN LI
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
| | - WANG DAN
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
| | - ZHENXIA LU
- Department of Hematology and Oncology, China-Japan Union Hospital Affiliated to Jilin University, Changchun, Jilin 130033, P.R. China
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