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Weekly Chest CasesArchive of Old Cases

Case No : 779 Date 2012-10-01

  • Courtesy of Hyun Ju Seon, Yun-Hyeon Kim / Chonnam National University Hospital
  • Age/Sex 29 / M
  • Chief ComplaintAbnormal lung lesion on CXR with underlying SLE
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1. Initial.

Diagnosis With Brief Discussion

Diagnosis
Extranodal marginal zone B-cell lymphoma (Marginal zone B-cell NHL of MALT)
Radiologic Findings
HRCT images of right mid and lower lung show mild interstitial thickening (especially, intralobular and interlobular interstitial thickening) and distal centrilobular branching opacities (due to thickening of peripheral centrilobular interstitum) with mild nodularities in right lower lobe (RLL) and right middle lobe. Enhanced chest CT shows a relatively homogeneously enhancing nodular consolidation abutting pleura in medial segment of right middle lobe (RML). These lesions show mild hypermetabolism (max: 3.6 at the lesion of RML and 2.3 at the lesion of RLL) on follow up FDG-PET CT.Follow up HRCT images of right mid and lower lung after 5 months, show aggravation of lesions with newly developed confluent peribronchovascular consolidation in peripheral and subpleural areas of RML and RLL.
Brief Review
Mucosa-associated lymphoid tissue (MALT) neoplasms constitute approximately 5% of all non-Hodgkin lymphoma. MALT lymphoma originates most frequently in various extranodal sites, approximately 51% of cases being in the gastrointestinal tract. Predisposing factors are autoimmune disease, chronic helicobacter pylori infection, and smoking. MALT lymphoma tends to remain localized in the affected organ for a prolonged period, being indolent and therefore responding well to therapy. These lymphomas, however, can progress to high-grade large B cell lymphoma. Primary pulmonary lymphoma is an uncommon neoplasm, the prevalence being less than 1%. The commonest radiological manifestations of pulmonary MALT lymphoma were pulmonary masses, or mass-like areas of consolidation and multiple pulmonary nodules. Common associated features included air-bronchogram, a positive angiogram sign on contrast enhanced CT, a halo of ground-glass shadowing or peribronchovascular thickening at tumor margins and discreet patches of ground-glass shadowing. These appearances are similar to the features described in secondary pulmonary lymphoma. In most cases the diagnosis of MALT lymphoma was made on either open or thoracoscopic biopsy, or following surgical resection. Needle biopsy, lavage and bronchial biopsy can provide a diagnosis. Use of PCR analysis and immunohistochemistry may be helpful.
References
1. Olga Maksimovic, Wolfgang A. Bethge, Jan P. Pintoffl, et al. Marginal Zone B-Cell Non-Hodgkin Lymphoma of Mucosa-Associated Lymphoid Tissue Type: Imaging Findings. AJR 2008; 191:921-930
2. Tonami H, Matoba M, Kuginuki Y, et al. Clinical lymphoma in patients with and imaging findings of Sj�gren syndrome. J Comput Assist Tomogr 2003; 27:517-524
3. Lewis ER, Caskey CI, Fishman EK. Lymphoma of the lung: CT findings in 31 patients. AJR 1991;156:711-714.
4. L.J. Kinmg, S.P.G. Padley, A.C. Wotherspoon, et al. Pulmonary MALT lymphoma: Imaging findings in 24 cases. Eur. Radiol 2000; 10:1932-1938.
Keywords
lung, lymphoproliferative disease,

No. of Applicants : 69

▶ Correct Answer : 16/69,  23.2%
  • - University of British Columbia , Canada Amr Ajlan
  • - Goa Medical College , India Paresh Desai
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Hanam sungshim hospital , Korea (South) CHANG IL KIM
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Asan Medical Center , Korea (South) Eunyoung Kim
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - CBNUH , Korea (South) jihyung lee
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
  • - All India Institute of medical sciences , India Justin Moses
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
▶ Correct Answer as Differential Diagnosis : 20/69,  29.0%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - GHICL , France manuel toledano
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - McGill University , Canada Michele Perillo
  • - Asan medical center , Korea (South) Sang Young Oh
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - Chungbuk univertisy hospital , Korea (South) Soohyun Lee
  • - Kaohsiung Veterans General Hospital , Taiwan Ming Ting Wu
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - CAC Rennes , France nicolas gautier
  • - IRSA , France, Metropolitan BIGOT
  • - MITOYO GENERAL HOSPITAL , Japan Mototsugu Saeki
  • - XiangYa hospital , China Xia Yu
▶ Semi-Correct Answer : 3/69,  4.3%
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Saint Malo , France jean-baptiste Noel
  • - Babaeski Devlet Hastanesi , Turkey Umut Ugur
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