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Weekly Chest CasesArchive of Old Cases

Case No : 1032 Date 2017-08-07

  • Courtesy of Suyon Chang, Hye-Jeong Lee / Severance Hospital
  • Age/Sex 66 / F
  • Chief ComplaintIncidental finding of abnormal lung nodules on health check-up
  • Figure 1
  • Figure 2
  • Figure 3
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  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Extranodal marginal zone B cell lymphoma (MALT lymphoma)
Radiologic Findings
Chest radiograph shows multiple nodular lesions in both lower lung fields.
Chest CT also shows multiple ill-defined nodular lesions in both lungs. The lesions show hypermetabolism on FDG-PET CT. Histopathologic examination on the specimens obtained by wedge resection of left upper lobe and left lower lobe revealed extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma).
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 maginal zone B cell lymphoma of the lung is sometimes referred to as bronchial-associated lymphoid tissue (BALT) lymphoma.
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, positive angiogram sign on contrast enhanced CT, halo of ground-glass shadowing or peribronchovascular thickening at tumour margins, and discrete patches of ground-glass shadowing. There appears to be no lobar predilection. 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, as the radiographic features are not diagnostic in isolation.
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

Please refer to
Case 1019 Case 860 Case 851 Case 811 Case 779 Case 426 Case 299 Case 272
Keywords
Mucosa-associated lymphoid tissue (MALT) lymphoma, Bronchus-associated lymphoid tissue (BALT) lymphom, Non-Hodgkin Lymphoma, Lymphoma,

No. of Applicants : 90

▶ Correct Answer : 13/90,  14.4%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - 怨„紐… , Korea (South) jin young kim
  • - Other , Korea (South) MINKYU KWAK
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
▶ Correct Answer as Differential Diagnosis : 36/90,  40.0%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - , Korea (South) HANKYUL KIM
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Other , Korea (South) SEONG SU KANG
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Ajou University School of Medicine , Korea (South) YOOLIM BAEK
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - McGill University / University College London , Canada Ilan Azuelos
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - HHS , Canada S LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chonnam National University Hospital , Korea (South) YOUNSU AHN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Other , Korea (South) DONGHWAN KIM
  • - District TB centre, kasaragod,India , India rikhy krishnan
  • - Ibaraki-gazou-shindan , Japan SHOICHI KATOH
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Seoul National University Hospital , Korea (South) YONGSUB SONG
  • - 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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