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Weekly Chest CasesArchive of Old Cases

Case No : 1108 Date 2019-01-21

  • Courtesy of Kum Ju Chae, Gong Yong Jin / Chonbuk National University College of Medicine
  • Age/Sex 64 / F
  • Chief ComplaintIncidental radiologic abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
MALT lymphoma
Radiologic Findings
Fig 1. Chest PA shows focal increased opacity in the right upper lung field.
Fig 2-6. Chest CT images demonstrate an ill-defined mass-like consolidation with air-bronchogram in the right upper lobe. Enhanced CT shows a relatively homogeneously enhancing consolidation. Former CT reveals that the size of the consolidation has slowly increased over the span of nine years. Percutaneous needle biopsy revealed Mucosa associated lymphoid tissue (MALT) lymphoma.
Brief Review
MALT lymphoma is a monoclonal lymphoid proliferation arising from a B-cell progenitor within bronchial associated lymphoid tissue (BALT), and is classified as low-grade marginal zone B-cell lymphoma. Radiography shows nodules, masses, and/or consolidation. CT shows multiple nodules, masses, and/or nodular/mass-like areas of ground-glass attenuation or consolidation, which tend to be in a bronchovascular distribution and often show air bronchogram. Halo of ground-glass shadowing or peribronchovascular thickening at tumor margins, and discrete patches of ground glass shadowing, positive angiogram sign on contrast enhanced CT can also be seen. Slowly progressive pulmonary consolidation in conjunction with a supportive history of autoimmune disease or lymphoma in another mucosal site should strongly suggest the diagnosis of MALT lymphoma. MALT lymphoma lesions are hypermetabolic at PET/CT approximately half of the time.
Treatment is usually with chemotherapy or immunotherapy (rituximab). Surgery and radiation therapy are options available for localized disease. The prognosis is good, with 5- and 10-year survival rates ranging from 84% to 88%.
References
1. Sirajuddin A, Raparia K, Lewis VA et al. Primary pulmonary lymphoid lesions: Radiologic pathologic findings. Radiographics. 2016 Jan-Feb;36(1):53-70.
2. O Donnel, PG, Jackson SA, Tung KT, Hassan B, Wilkins B, Mead GM. Radiological appreance of lymphomas arising from Mucosa-associated lymphoid tissue (MALT) in the lung. Clinical Radiology 1998;53:258-263.
3. King LJ, Padley SP, Wotherspoon AC, Nicholson AG. Pulmonary MALT lymphoma: imaging findings in 24 cases. Eur Radiol 2000;10(12):1932-8
Please refer to
Case 851 Case 1032 Case 1049 Case 1071
Keywords
Lung, Neoplasm_Malignant,

No. of Applicants : 70

▶ Correct Answer : 20/70,  28.6%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - , Japan MASAFUMI KAIUME
  • - Affilitated Hospital of Jining Medical University , China HUA SHENG JIANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Japan NAOMI YUASA
  • - Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
▶ Correct Answer as Differential Diagnosis : 17/70,  24.3%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - The Jikei university , Japan TAKU GOMI
  • - MAGNUM DIAGNOSTICS - Goa INDIA , India PARESH K DESAI
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Private sector , Greece VASILIOS TZILAS
  • - Japanese Red Cross Wakayama Medical Center , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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