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Weekly Chest CasesArchive of Old Cases

Case No : 1071 Date 2018-05-07

  • Courtesy of Jae Wook Lee, Eun-Young Kang, Hwan Seok Yong / Korea University Guro Hospital
  • Age/Sex 68 / M
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
MALT lymphoma
Radiologic Findings
Fig 1-3. Lung (Fig 1-2) and mediastinal (Fig 3) window settings of the chest CT scan shows diffuse consolidation and ground-glass opacities in both lower lobes.
Figs 4-5. PET-CT scan shows diffuse hypermetabolic consolidation in both lower lobes.

The patient had history of gastric MALToma treated 3 years ago. He had difficulty breathing from three months ago, and the symptoms became worse over time. Surgical lung biopsy was performed for diagnosis and malignant lymphoma was diagnosed.
Brief Review
Extranodal marginal zone B cell lymphoma, also called low grade B cell lymphoma of mucosa associated lymphoid tissue (MALT), is an extranodal lymphoma that arises in a number of epithelial tissues, including the stomach, salivary gland, lung, small bowel, thyroid, and elsewhere. Extranodal marginal zone B cell lymphoma of the lung is sometimes referred to as bronchial-associated lymphoid tissue (BALT) lymphoma.
On chest radiographs, recurrent or secondary pulmonary lymphoma may present with various patterns: bronchovascular or lymphangitic with thickening of bronchovascular bundles and interlobular septae (41%), discrete pulmonary nodular (39%), pneumonic or alveolar with areas of consolidation (14%), and miliary or hematogenous with disseminated micro nodules (6%) 1251. Lymphadenopathy and pleural effusion is also commonly present. Other manifestations include cavitary and endobronchial masses.
Lewis et al. 151 reviewed the CT findings of pulmonary parenchyma lymphoma in 31 patients with recurrent or secondary non-Hodgkin’s or Hodgkin’s disease. In that study, the most common CT findings were masses or mass-like areas of consolidation larger than 1 cm (68% of patients) and nodules smaller than 1 cm (61 % of patients), slightly different from the results of previous studies on radiographs. However, three or more CT abnormalities were present in 68% of patients.
Lymphomatous involvement of the lung is often asymptomatic, and when symptoms do occur, they are often nonspecific, thus making the clinical diagnosis difficult. Diagnosis is also difficult because infection, granulomatous disease, primary or secondary carcinomas, or drug reactions may cause similar abnormal radiologic findings. Careful correlation of clinical, microbiologic, and histologic findings is
necessary.
References
1. Imaging of pulmonary lymphomas. K S Lee, Y Kim, S L Primack. American Journal of Roentgenology. 1997;168:339-345.
Keywords
Lung, Neoplasm_Malignant,

No. of Applicants : 107

▶ Correct Answer : 33/107,  30.8%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Myongji Hospital , Korea (South) KYUNGHO KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - The Jikei university , Japan TAKU GOMI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Korea (South) HYO JAE LEE
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - eskisehir devlet hastanesi , Turkey MURAT SAHIN
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - , Korea (South) SUNGEUN YUN
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - , Korea (South) JONGSUN LEE
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Al Buraimi Medical Center , Oman WESAM ASEL NASSER
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - , China YIN LIU
▶ Correct Answer as Differential Diagnosis : 35/107,  32.7%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - , Japan SHIMPEI KATO
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - M P Shah Medical College Jamnagar Gujarat , India AKSHAY PARAMESHWAR PENDKAR
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - Other , Korea (South) SEONGSU KANG
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - HHS , Canada S LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ewha Womans University Medical Center , Korea (South) YOUNGSUN KO
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - TB centre kasaragod. , India rikhy krishnan
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Private sector , Greece VASILIOS TZILAS
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
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