Primary Pulmonary Mucosa-associated Lymphoid Tissue Lymphoma Combined with Idiopathic Thrombocytopenic Purpura and Amyloidoma in the Lung

Abstract

Three abnormal shadows were detected in the right lung on chest X-ray films and computed tomography in a 75-year-old woman during follow-up for idiopathic thrombocytopenic purpura. Because a definitive diagnosis was not obtained through general examinations, exploratory thoracotomy was performed for diagnosis and treatment. The main lesion in the right middle lobe was diagnosed as mucosa-associated lymphoid tissue (MALT) lymphoma according to histopathological findings, cytogenic studies and reverse transcriptase-polymerase chain reaction analysis, and nodular lesions in S(3) and S(7) were diagnosed with Congo-red staining as local deposition of amyloid. The patient had no recurrence of the MALT lymphoma of the lung or other organs for 4 years after surgery. To our knowledge, this is the first reported case of primary pulmonary MALT lymphoma combined with idiopathic thrombocytopenic purpura/lung amyloidoma.

Two cases of monoclonal nodular pulmonary amyloidosis and review of the literature

“…Particularly of the popyclonal type, approximately one hundred cases have been reported in the literature of NPA (Table 1). 3,[5][6][7][8][9][10][11][12][13][14][15][16][17] NPA is typically of the AL variant, specifically lambda light chain despite the usual association of AL amyloid with systemic amyloidosis. [2][3][4]15 The amyloid is speculated to arise from a reaction to chronic inflammatory conditions of the lung, including connective tissue disorders, tuberculosis, or HIV infection.…”

Autoimmune thrombocytopenia in non-Hodgkin's lymphomas

“…Seven MZL-patients associated with ITP have been reported, including four patients with MALT lymphoma, [19][20][21][22] two with splenic lymphoma with villous lymphocytes (SLVL) 23 and one with a nodular MZL.…”

“…In three cases the ITP was diagnosed 1-10 years before diagnosis of lymphoma, in the other cases at the diagnosis of lymphoma. The MALT lymphomas were gastric lymphomas in three cases 19,21,22 and a lung MALToma in one case 20 (stage IE to IIE). All patients in whom the lymphoma was removed surgically (± subsequent chemotherapy) 19,21 or who received chemotherapy alone 22 achieved a CR of ITP.…”

A Case of Primary Pulmonary Diffuse Large B-Cell Lymphoma Diagnosed by Transbronchial Biopsy

“…2) PPLs represent <1% of primary malignant lung tumors, <1% of lymphomas, and only 3%-4% of extranodal lymphomas. 3) A commonly used set of criteria for PPL proposed by L'Hoste and associates is lymphoma with involvement of the lung, lober, or primary bronchus, with or without mediastinal involvement, and no evidence of extrathoracic lymphoma at the time of diagnosis or for 3 months thereafter.…”

“…2) Because the rate of local recurrence after complete resection is reported to be high, adjuvant chemotherapy or radiation therapy should be considered for non-MALT lymphomas. 8) Because our patient had DLBCL and a high MIB index, chemotherapy was planned at the department of hematology.…”