HRCT in primary pulmonary lymphoma: can CT imaging phenotypes differentiate histological subtypes between mucosa-associated lymphoid tissue (MALT) lymphoma and non-MALT lymphoma?

Abstract

Background: Primary pulmonary lymphoma (PPL) mainly comprises mucosa-associated lymphoid tissue (MALT) lymphoma as well as other subtypes of lymphoma. Different phenotypes of PPL demonstrate various high-resolution computed tomography (HRCT) features. We aimed to evaluate the value of HRCT in the diagnosis and differential diagnosis of PPL, especially between MALT lymphoma and non-MALT lymphoma and the correlation between CT and pathological features. Methods: We performed a retrospective analysis on 72 patients with PPL confirmed by pathology between 2007 and 2016. We compared the CT characteristics and correlation with pathological findings between MALT lymphoma and non-MALT lymphoma groups. Results: All 72 patients with PPL were classified into two groups: low-grade MALT lymphoma (MALToma) (56/72) and high-grade non-MALT lymphoma (non-MALToma) (16/72). The latter group consisted of diffuse large B cell lymphoma (8/72), Hodgkin's lymphoma (3/72), T-cell lymphoma (4/72), and intravascular large B-cell lymphoma (1/72). A total of 168 lesions were analyzed, including 57 cases with multiple lesions and 15 cases with single lesion. The manifestation of four distribution patterns: nodular or mass-like involvement pattern, diffuse interstitial lung disease (DILD) pattern, pneumonia-like consolidative pattern and mixed pattern was not significantly different between MALToma and non-MALToma (all P>0.05). Signs of air bronchogram and CT angiogram occurred significantly more often in individuals with MALToma group than those with non-MALToma (75% vs. 25%, P=0.001; 64.3% vs. 12.5%, P<0.001; respectively). Conversely, the halo sign presented more often in non-MALToma than in MALToma patients (19% vs. 63.6%, P=0.02). In addition, the butterfly sign was only observed in four patients with MALToma. Conclusions: HRCT imaging phenotypes were beneficial in the diagnosis of PPL. Solitary or multifocal nodules/ masses and consolidation were the most common imaging patterns. The air bronchogram sign, CT angiogram sign, halo sign, and butterfly sign could be potential to help to differentiate MALToma from non-MALToma.

Pulmonary Intravascular Large B-cell Lymphoma in a Patient Administered Methotrexate for Rheumatoid Arthritis

“…The patterns observed most frequently in the lungs of patients with DLBCL are consolidation, nodules and mass lesions (15)(16)(17). However, diffuse ground-glass opacity has been very rarely reported (17). This is a rare case of MTX-associated pulmonary DLBCL showing ground-glass opacity on CT with histopathological confirmation of the lesion as IVLBCL.…”

“…DLBCL is the common histologic type of MTX-LPD, and its typical clinical features have been reported to be lymphadenopathy or a mass lesion in an extranodal location (3-9), including the skin, liver, spleen, lung, gastrointestinal tract, and bone marrow (3)(4)(5)(6)(7)(8)14). The patterns observed most frequently in the lungs of patients with DLBCL are consolidation, nodules and mass lesions (15)(16)(17). However, diffuse ground-glass opacity has been very rarely reported (17).…”

CT Imaging Characteristics Correlated with Overall Survival Time in Patients with AIDS-Related non-Hodgkin’s Lymphoma

“…With the advancement of imaging technology such as CT, MR and PET/CT, radiologic techniques play an increasingly essential role in detecting lesion and evaluating disease (8)(9)(10). CT can nd the enlargement of lymph nodes and in ltration of extranodal organs, guide biopsy and observe early relapse through follow-up (11,12). MR has similar e cacy of detecting the space occupying effect with CT.…”

T-cell lymphoma with a granulomatous lesion of the lungs after autologous hematopoietic stem cell transplantation against Epstein–Barr virus-positive diffuse large B-cell lymphoma: a case report

“…Seventy to 80% of PPL cases are B cell origin (27). In contrast, primary pulmonary T-cell lymphoma cases are rare and have been reported mostly in case studies (28,29).…”