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Weekly Chest CasesArchive of Old Cases

Case No : 272 Date 2003-01-11

  • Courtesy of Chin A Yi, M.D. Tae Sung Kim, M.D., Kyung Soo Lee, / Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • Age/Sex 60 / M
  • Chief ComplaintIncidentally detected abnormality on chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
BALT Lymphoma
Radiologic Findings
A dominant mass is seen in the anterior segment of the right upper lobe with multiple nodules along bronchovascular bundles in both lungs, which findings are highly suggestive of BLAT lymphoma. Gun biopsy was done on dominant mass in right upper lobe. Pathologic specimen disclosed many small to medium sized lymphoid cells, clusters of follicular dendritic cells and fragments of bronchial epithelium, which are consistent with marginal zone B-cell lymphoma of MALT type.
Brief Review
Mucosa-associated lymphoid tissue (MALT) lymphoma arises in the extranodal mucosal lymphoid tissue and has only been recognized as a distinct entity in recent years. It affects one or several extranodal structures such as the stomach, the lung, the eye and salivary glands. When bronchial mucosa is involved, it could be called bronchial associated lymphoid tissue (BALT) lymphoma. The lymphoma is generally of low grade and has indolent course. The disease is often localized at the time of diagnosis and responds favorably to local treatment, but the optimal management is not clearly defined. Overall, BALT lymphoma has a favorable prognosis and is associated with long-term survival (1).
According to Lee et al. (2), pulmonary lesions were revealed as airspace consolidation in six patients (60%) and nodule(s) in six (60%). Multiplicity of disease was seen in seven patients (70%) and bilateral lung lesions in six (60%). Areas of ground-glass attenuation were seen in seven patients (70%). Bubble-like radiolucencies were present in five patients (50%) and air bronchogram in nine (90%). Findings of bronchial dilatation and lymphadenopathy were seen in three patients (30%).
In other report reviewing 24 cases of BALT lymphoma (18 chest radiograph and 17 CT scans), multiple pulmonary lesions were identified in 19 of 24 patients (79%) and solitary lesions in 4 of 24 patients (17%). Diffuse pulmonary infiltration was present in 1 patient. Lesions included masses or mass-like areas of consolidation (n = 21) and pulmonary nodules (n = 18). Associated findings were air bronchograms, airway dilatation, a positive angiogram sign and a halo of ground-glass shadowing at lesion margins. Peribronchovascular thickening was also observed, as were hilar or mediastinal lymph node enlargement and pleural effusions or thickening (3).
Although rare, the diagnosis of pulmonary MALT lymphoma should be considered in patients with the imaging features described, particularly when in association with an indolent clinical course or a history of autoimmune disease.
References
1. Ahmed S, Siddiqui AK, Rai KR. Low-grade B-cell bronchial associated lymphoid tissue (BALT) lymphoma. Cancer Invest 2002;20(7-8):1059-68
2. Lee DK, Im JG, Lee KS, Lee JS, Seo JB, Goo JM, Kim TS, Lee JW. B-cell lymphoma of bronchus-associated lymphoid tissue (BALT): CT features in 10 patients. J Comput Assist Tomogr 2000 Jan-Feb;24(1):30-4
3. King LJ, Padley SP, Wotherspoon AC, Nicholson AG. Pulmonary MALT lymphoma: imaging findings in 24 cases. Eur Radiol 2000;10(12):1932-8
Keywords
Lung, Lymphproliferative disorder,

No. of Applicants : 15

▶ Correct Answer : 9/15,  60.0%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - CHU Nancy-Brabois, France Denis Regent
  • - Chungju Hospital Konkuk University, Korea Chang Hee Lee
  • - Hadong Hospital, Korea Seok Bin Seo
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Sarang Hospital, Incheon, Korea Jung Hee Kim
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
▶ Semi-Correct Answer : 2/15,  13.3%
  • - CHU Grenoble, France Gilbert Ferretti
  • - Kangdong Sacred Heart Hospital, Korea Young Cheol Yoon
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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