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Weekly Chest CasesImaging Conference Cases

Case No : 5

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  • Age/Sex 36 / F
  • Case Title Treatment ro RA and fibromyalgia syndrome for 4 years
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Diagnosis With Brief Discussion

Courtesy
Hanyang University Hospital, Seoul Korea
Definitive Diagnosis
Diagnostic method

Open lung biopsy of right middle lobe
Discussion
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.
Keywords
Lung, Malignant tumor, Lymphoma,
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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