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Weekly Chest CasesArchive of Old Cases

Case No : 1296 Date 2022-08-22

  • Courtesy of Kyung Eun Shin / Soonchunhyang University Hospital Bucheon
  • Age/Sex 75 / F
  • Chief ComplaintRectal cancer metastasis work up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

initial

Diagnosis With Brief Discussion

Diagnosis
MALT lymphoma
Radiologic Findings
Fig 1-2. Initial chest CT scans reveal small nodules in the right upper lobe and right major fissure.
Fig 3-5. F/U chest CT scans 3 years later show that nodules increased and other new nodules with peribronchial distribution appeared in both lungs.
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
Keywords
MALT lymphoma,

No. of Applicants : 83

▶ Correct Answer : 41/83,  49.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - , Korea (South) JIN YOUNG LEE
  • - Osaka University , Japan AKINORI HATA
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Korea (South) KIM HYE IN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - , Japan YUMI MAEHARA
  • - , Japan YUKI HAYASHI
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 13/83,  15.7%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Yamanashi Prefectural Hospital , Japan HIROAKI WATANABE
  • - , Japan KENTARO KOTANI
  • - Other , Korea (South) CHAEHUN LIM
  • - Other , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
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