SESSION TYPE: Cancer Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Primary non-Hodgkin’s lymphoma of the lung is a rare and insidious disease that accounts for less than 1% of all lymphomas. Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma or bronchial tissue associated (BALT) lymphoma comprise only 0.4% of all primary lung lymphomas.
CASE PRESENTATION: A 67 year-old Caucasian female was referred to our specialty clinic for an abnormal chest CT scan and fatigue. Her past medical and surgical history are significant for kyphoscoliosis for which she has undergone multiple back surgeries; hypertension, fibromyalgia, and allergic rhinitis. She has had old chest radiographs through the years, the oldest of which was about eight year old, that showed persistent opacities in her right lower lobe and lingular areas. A chest CT scan that was done just prior to the consultation showed areas of dense consolidation and ground glass changes in the right lower lobe and lingula. The patient, though mostly asymptomatic apart from fatigue, opted to undergo tissue diagnosis through fluoroscopy-guided bronchoscopic trans-bronchial biopsy. Histologic examination of tissue samples was consistent with a MALT lymphoma. She is currently undergoing chemotherapy and has since felt improved.
DISCUSSION: Malignant lymphoma secondarily involves the lung with an incidence of 25-40%. Primary pulmonary lymphoma of the mucosa-associated lymphoid tissue (MALT) type, however, accounts for only 0.4% of all lymphomas. This is a low grade B-cell extranodal lymphoma that is characterized by proliferation of clonal marginal zone lymphocytes that invade epithelial structures and form lymphoepithelial lesions. Bronchial associated lymphoid tissue (BALT), the precursor of this disease, is not a normal constituent of the human lungs. The development of BALT is thought to be associated with chronic antigenic stimulation. MALT lymphoma is diagnosed mostly through tissue sampling, and it has been found that bronchoscopy with transbronchial biopsy has a low yield in diagnosis this disease. In one case series, there was a median delay between the first transbronchial biopsy and diagnosis of MALT lymphoma of 3 months. It is an indolent disease with a median duration of first symptom or radiologic abnormalities at 9 months to 27 months.
CONCLUSIONS: MALT lymphoma is a rare disease with an indolent course that is diagnosed mostly through surgical tissue sampling. Though much about it is still unknown and there are no consensus on therapy, its ten year mortality has been described to be good.
1) Ferraro P, Trastek VF et al. Primary Non-hodgkin’s lymphoma of the lung. Annals of Thoracic Surgery 2000, 69, 993-997.
2) Borie R, Wislez M, Thabut G, et al. Clinical characteristics and prognostic factors of pulmonary MALT lymphoma. European Respiratory Journal 2009; 34: 1408-1416.
3) Ahmed S, Kussick S, Siddiqui A, et al. Bronchial-associated lymphoid tissue lymphoma: a clinical study of a rare disease. European Journal of Cancer 2004; 40: 1320-1326.
DISCLOSURE: The following authors have nothing to disclose: Katherine There Cayetano
No Product/Research Disclosure InformationUC Davis Medical Center, Sacramento, CA