Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma in a Patient With Acquired Immune Deficiency Syndrome

Verma, Vishal; Jain, Shilpa; Singhal, Shashideep; Nallagatla, Sasikanth; Majumdar, Ayanava; Vangala, Mary; Arjomand, Farhad; Vasudevan, Viswanath

doi:10.4187/respcare.00780

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Although there had been several retrospective case reports, few studies were investigated in the Asian population. PPLwas commonly misdiagnosed as pneumonia, pulmonary abscess and carcinoma as reported [ 9 , 10 , 23 – 25 ]. The main cause of misdiagnosis were summarized as follow: 1) The limitation of specialists.…”

Section: Discussionmentioning

confidence: 99%

Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study

Yao

Zhang

et al. 2018

BMC Cancer

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BackgroundThe primary pulmonary lymphoma (PPL), with a low incidence, was highly misdiagnosed in clinic. The present study analyzes the clinical features, laboratory and imaging data, pathologic characteristics, and summarizes misdiagnosis reasons of PPL cases, aims to provide a better understanding and increase the accuracy of early diagnosis and minimize the misdiagnosis of PPL.MethodsThe clinical data of 19 cases were collected from the first affiliated hospital of Wenzhou medical university (PRC) from April 2010 to May 2016. All cases were confirmed by pathology. The process of misdiagnosis was described. This study retrospectively analyzed the incidence, clinical presentation, laboratory examination, Chest CT scan and diagnosis of the cases.ResultsThe symptoms of the 19 cases were dyspnea, fever, hemoptysis, chest pain or physical findings without obvious symptoms. Five patients were pneumonia-like, nine patients had lung single nodule or mass and four patients got pleural effusion, which were reported by computed tomography (HRCT) scan. There were 2 cases of Hodgkin lymphoma (HL), and 17 cases of non-Hodgkin lymphoma (NHL). In NHL cases, 12 cases were confirmed mucosa associated lymphoid tissue B lymphoma type, 3 cases were confirmed diffuse large B-cell lymphoma, angioimmunoblastic T-cell lymphoma and ALK positive anaplastic large cell lymphoma were one case separately. Clinical and imaging manifestation of PPL is untypical, but there are still some hints: 1) Fuzzy shadow at the edge of lung mass with air bronchogram; 2) Lung mass shadow stable for a long time; 3) Pneumonia-like changing without infections clinical and lab manifestation. Thirteen patients (68.4%) were misdiagnosed as pneumonia, lung cancer and tuberculosis initially. The term between initial diagnosis and final diagnosis lasted for half a month up to 2 years, with median time of 6 months. Two cases were misdiagnosed as tuberculosis. One case was misdiagnosed as small cell lung cancer.ConclusionClinical and imaging manifestation of PPL is untypical. Biopsies should be taken actively if the imaging findings don’t match the symptoms or the anti-infection treatments to “lung infection” don’t work. Accurate diagnosis requires adequate tissue sampling with appropriate ancillary pathologic studies. If clinical manifestation and the diagnosis don’t match, repeated biopsy should be ordered.

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Section: Discussionmentioning

confidence: 99%

Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study

Yao

Zhang

et al. 2018

BMC Cancer

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“…MALT lymphoma is considered to have high correlation with chronic antigenic stimulation (especially Helicobacter pylori to gastric MALT lymphoma), chronic inflammation and autoimmune disease. It was reported that smoking or autoimmune diseases, such as systemic lupus erythematosus, may be associated with pulmonary MALT lymphomas [4]. The chromosome translocations such as t (11; 18) (q21; q21), t (1; 14) (p22; q32) and t(14; 18) (q32; q21) also take part in the pathogenesis of MALT lymphomas [5].…”

Section: Discussionmentioning

confidence: 99%

A young man with an unchanged consolidation in chest CT

Zhao

Guo

2019

Respiratory Medicine Case Reports

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Primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. MALT lymphoma patients usually show no clinical symptoms or physical signs. Chest radiograph or computed tomography (CT) may confuse MALT lymphoma with other pulmonary diseases, which would lead to misdiagnosis or a delayed diagnosis. In the present study, a 33-year-old male patient had cough and fever. Chest CT showed consolidation on both sides. Those clinical symptoms disappeared after he had been misdiagnosed and treated for community-acquired pneumonia for three weeks. However, further chest CT still showed the consolidation without any change. Then an ultrasonic guided transthoracic needle biopsy was performed. Morphological changes indicated the diagnosis of extranodal marginal Zone B cell lymphoma of MALT. The patient was then treated with chemotherapy and rituximab. After this line of treatment, the consolidation decreased.

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“…The pathogenesis of this illness remains unclear; however, chronic antigenic stimulation, as in autoimmune disease, infection, and/or smoking, has been suggested as a trigger, which supports the fact that deregulation of lymphoid cell function may be involved [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Bronchiectasis as a Presentation Form of Pulmonary Marginal Zone B-Cell Lymphoma of Bronchus Associated Lymphoid Tissue

Ernst

Torres

Borsini

et al. 2015

Case Reports in Oncological Medicine

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The pulmonary marginal zone B-cell lymphoma of bronchus associated lymphoid tissue of the lung (BALT) is a rare illness that can remain without symptoms. Radiological findings of pulmonary lymphoma are heterogeneous. In literature, bronchiectasis is only described in one patient who also had besides adenomegalies. We reported on a 48-year-old female patient. She showed symptoms consistent with dyspnea with productive cough; there were crepitant sounds in the auscultation. Pulmonary functional test has shown a severe restrictive pattern with a low FVC and DLCO. CT scan showed bronchiectasis in the medium lobule without adenomegalies. Echocardiogram was normal, and the laboratory findings only showed leukocytosis. There were no findings in the bronchoscopy, but the lung biopsy showed a B-cell pulmonary lymphoma (positive to CD20 and CD79a in immunostaining). A wide variety of radiological manifestations has been previously described; however, we have presented this rare case, with bronchiectasis, as unique radiological finding.

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Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma in a Patient With Acquired Immune Deficiency Syndrome

Cited by 5 publications

References 11 publications

Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study

Clinical and misdiagnosed analysis of primary pulmonary lymphoma: a retrospective study

A young man with an unchanged consolidation in chest CT

Bilateral Bronchiectasis as a Presentation Form of Pulmonary Marginal Zone B-Cell Lymphoma of Bronchus Associated Lymphoid Tissue

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