Lung Cancer |

Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma: A Rarely Observed Primary Malignancy of the Lungs FREE TO VIEW

Woo Moon, DO; Sweta Kakaraparthi, MD; Thomas Gravelyn, MD
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St Joseph Mercy Hospital, Ypsilanti, MI

Chest. 2014;146(4_MeetingAbstracts):650A. doi:10.1378/chest.1989015
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SESSION TITLE: Cancer Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary pulmonary lymphomas are infrequently observed malignancies of the respiratory system. Among them, mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphomas are the two most commonly seen primary pulmonary lymphomas [1]. Although gastric MALT lymphoma has been shown to have strong associations with Helicobacter pylori infections, the etiology of pulmonary MALT lymphoma remains unclear. Though it carries an excellent 5 year survival rate (>80%), recognition of this indolent lymphoma is essential for determining treatment options.

CASE PRESENTATION: A 54 year old woman presented to the emergency department with chest pain and dyspnea. Although a full cardiac workup was unrevealing, chest computed tomography (CT) with contrast performed to address concerns for pulmonary embolism revealed scattered bilateral ground-glass opacities (Fig. 1). She received a bronchoscopy with biopsy after a follow-up CT failed to show resolution of the mass. Pathologic evaluation revealed atypical lymphoid infiltrates that were immunostain positive for B cell marker CD20 and T cell marker CD43 concerning for MALT lymphoma. Video-assisted thorascopic exploration of the left lung with excision of the opacities confirmed the diagnosis (Fig. 2). Subsequent positron emission tomography CT did not demonstrate extrapulmonary manifestations and esophagogastroduodenoscopy with biopsy confirmed the absence of concurrent Helicobacter pylori infection. She is currently followed by a multidisciplinary team of physicians and remains disease free.

DISCUSSION: Primary pulmonary MALT lymphoma equally affects both genders and peaks around the 6th decade of life. Unlike primary gastric MALT lymphomas, primary pulmonary MALT lymphomas are not known to be associated with infections [2]. It is important to note that radiographs may reveal multifocal nodules and ground-glass opacities [3]. Although these findings may be mistaken for atypical pneumonia, indolent B-cell lymphomas such as pulmonary MALT lymphomas should be considered.

CONCLUSIONS: Though primary pulmonary lymphomas are rare, this case demonstrates the importance of considering pulmonary MALT lymphoma as a cause of multifocal ground-glass opacities. Definitive diagnosis should be pursued promptly as treatment modalities and prognosis differs drastically between different primary pulmonary malignancies.

Reference #1: Borie, R., et al., Clinical characteristics and prognostic factors of pulmonary MALT lymphoma. Eur Respir J, 2009. 34(6): p. 1408-16.

Reference #2: Michael, C.W., P.H. Richardson, and C.W. Boudreaux, Pulmonary lymphoma of the mucosa-associated lymphoid tissue type: Report of a case with cytological, histological, immunophenotypical correlation, and review of the literature. Ann Diagn Pathol, 2005. 9(3): p. 148-52.

Reference #3: Hare, S.S., et al., The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol, 2012. 85(1015): p. 848-64.

DISCLOSURE: Thomas Gravelyn: Consultant fee, speaker bureau, advisory committee, etc.: Speaker bureau for Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: Speaker bureau for Forest Pharmaceuticals, Consultant fee, speaker bureau, advisory committee, etc.: Speaker bureau for Sunovion Pharmaceuticals The following authors have nothing to disclose: Woo Moon, Sweta Kakaraparthi

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