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Weekly Chest CasesArchive of Old Cases

Case No : 811 Date 2013-05-13

  • Courtesy of Hyun Jung Kim, Myung Im Ann, Jung Im Jung, Dae Hee Han / Seoul St. Mary Hospital
  • Age/Sex 77 / M
  • Chief Complaintnight cough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

initial chest PA

Diagnosis With Brief Discussion

Diagnosis
BALT lymphoma
Radiologic Findings
Initial chest PA shows a patchy consolidation in the lower portion of the Rt upper lobe and around the Rt hilum. Patchy consolidation with air-bronchogram, surrouding ground glass opacities in RUL and minimally in LUL appears on the initial chest CT. The extent of the lesions is similar on the follow up chest radiography and CT. BALT lymphoma was proven by the broncoscopic biopsy.
Brief Review
Mucosa-associated lymphoid tissue (MALT) lymphoma arises in the extranodal mucosal lymphoid tissue. When located in the lung, this lymphoma appears to arise from bronchus-associated lymphoid tissue (BALT). BALT lymphoma represents a low-grade B lymphocyte lymphoma that is composed of monotonous small lymphocytes with focal plasmacytoid features. The origin of the cell is thought to be a B lymphocyte from the marginal zone of the lymphoid follicle.
The commonest radiological manifestations of pulmonary MALT lymphoma were pulmonary masses, or mass-like areas of consolidation and multiple pulmonary nodules. Common features associated with pulmonary MALT lymphoma included air bronchogram, a positive angiogram sign on contrast enhanced CT, a halo of ground-glass shadowing or peribronchovascular thickening at tumour margins and discret patches of ground-glass shadowing. It tends to be confined to the lung for a long time, without involvement of hilar and mediastinal lymph nodes or other organs. The possibility that pulmonary lymphoma with lymphadenopathy represented spread of nodal lymphomas to the lung was considered but is thought to be highly unlikely due to the characteristic histological appearances of MALT lymphoma in the pulmonary infiltrates.
The differential diagnosis of non-resolving consolidation includes bronchiolitis obliterans with organizing pneumonia, eosinophilic pulmonary syndromes, pulmonary alveolar proteinosis, drug-induced lung disease, and neoplastic disorders. Although the imaging finding are nonspecific, it is important for radiologists to have high index of suspicion for lymphoma, especially in patients with indolent clinical course or a history of autoimmune disease
References
1. 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.
2. King LJ, Padley SP, Wotherspoon AC, Nicholson AG. Pulmonary MALT lymphoma: imaging findings in 24 cases. Eur Radiol 2000;10(12):1932-8
3. Ahmed S, Siddiqui AK, Rai KR. Low-grade B-cell bronchial associated lymphoid tissue (BALT) lymphoma. Cancer Invest 2002;20(7-8):1059-68
Please refer to
Case 426 Case 299 Case 272
Keywords
Lung, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 92

▶ Correct Answer : 25/92,  27.2%
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
  • - Dongtan Sacred Heart Hospital , Korea (South) Younghwan Ko
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - radiologist, aditya imaging centre , India vivek patel
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - DONGTAN SACRED HEART HOSPITAL , Korea (South) BOYONG CHUNG
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - SKG radiology , Australia Yuranga Weerakkody
  • - SNUH , Korea (South) Euijin Hwang
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - 異⑸ , China ZHANG YING
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Samsung medical center , Korea (South) Soyi Kwon
  • - Samsung Medical Center , Korea (South) Jihyun LEE
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Kyoto University , Japan Akihiko Sakata
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - chp st martin , France Mariotte benoit
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Korea university anam hospital , Korea (South) Sung-Hye You
▶ Correct Answer as Differential Diagnosis : 36/92,  39.1%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Soonchunhyang University Seoul Hospital , Korea (South) EUNSUN OH
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - GHICL , France manuel toledano
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - CHU Poitiers , France Charles SIMONET
  • - Montreal , Canada Drago Le King
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - sunder lal jain hospital , India sanjeev vachher
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Myongji , Korea (South) soon-young Moon
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - CHU Poitiers , France CHAN paul
  • - Saint Malo , France jean-baptiste Noel
  • - CAC Rennes , France nicolas gautier
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - McGill university , Canada Badriya Al-Qassabi
  • - Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
  • - All India Institute of medical sciences , India Justin Moses
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Private sector , Greece Vasilios Tzilas
  • - CNUH , Korea (South) Kim Hyun
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