Korean J Radiol.  2013 Apr;14(2):366-374. 10.3348/kjr.2013.14.2.366.

Primary Endobronchial Marginal Zone B-Cell Lymphoma of Bronchus-Associated Lymphoid Tissue: CT Findings in 7 Patients

• Yoon RG
• Kim MY
• Song JW
• Chae EJ
• Choi CM
• Jang S

• KMID: 1482801
• DOI: http://doi.org/10.3348/kjr.2013.14.2.366

Abstract

OBJECTIVE
To investigate CT and 18F-flurodeoxyglucose (18F-FDG) positron-emission tomography/CT findings of primary endobronchial marginal zone B-cell lymphoma of the bronchus-associated lymphoid tissue (BALT).
MATERIALS AND METHODS
From June 2006 through April 2012, seven patients (six female, one male; age range, 21-61 years; mean age, 49 years) were examined who were pathologically diagnosed with the primary endobronchial marginal zone B-cell lymphoma of BALT. We evaluated the locations and characteristics of the lesions on CT and 18F-FDG-PET/CT scans. The lesions were classified into the following three patterns: 1) solitary intraluminal nodule; 2) several tiny nodular protrusions; and 3) diffuse wall thickening.
RESULTS
A solitary intraluminal nodule was observed in four patients (57.1%), several tiny nodular protrusion in two patients (28.6%), and diffuse wall thickening in one patient (14.3%). The lesions were categorized into 3 major locations: confined to the trachea (n = 3), confined to the lobar bronchus (n = 2), and diffuse involvement of the trachea and both main bronchi (n = 2). All lesions demonstrated homogeneous iso-attenuation as compared with muscle on pre- and post-enhancement scans. Secondary findings in the lungs (n = 3; 42.9%) included postobstructive lobar atelectasis (n = 1), air trapping (n = 1), and pneumonia (n = 1). On 18F-FDG-PET/CT (n = 5), 4 lesions showed homogeneous uptake with maximum standardized uptake values (mSUV), ranging 2.3-5.7 (mean mSUV: 3.3). One lesion showed little FDG uptake.
CONCLUSION
Primary endobronchial marginal zone B-cell lymphoma of the BALT manifests as three distinct patterns on CT, with the solitary intraluminal nodule presenting as the main pattern. Most lesions demonstrate homogeneous but weak FDG uptake on 18F-FDG-PET/CT.

Keyword

Bronchial neoplasms; Lymphoma, non-Hodgkin/diagnosis; Lymphoma, non-Hodgkin/radiotherapy; Bronchus-associated lymphoid tissue; Tomography, X-ray computed; Positron-emission tomography

MeSH Terms

Adult
Biopsy
Bronchi/pathology
Female
Fluorodeoxyglucose F18/diagnostic use
Humans
Immunohistochemistry
Lymphoid Tissue/pathology
Lymphoma, B-Cell, Marginal Zone/pathology/*radiography/radionuclide imaging
Male
Middle Aged
Radiopharmaceuticals/diagnostic use
Retrospective Studies
Tomography, X-Ray Computed/*methods
Radiopharmaceuticals
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Endobronchial marginal zone B-cell lymphoma of BALT in left upper lobar bronchus of 56-year-old woman who presented with 3-month history of dyspnea (patient 6 in Table 1). A, B. Enhanced CT with transverse, coronal images showing homogeneous enhancement of endobronchial mass with distal left upper lobar atelectasis and compression of left pulmonary artery. C. 18F-FDG-PET/CT image showing hypermetabolic mass at upper left lobar bronchus (maximum SUV = 5.7). D. Bronchoscopy showing endobronchial submucosal mass at distal portion of left main bronchus with near-total obstruction of left upper lobar bronchus. E, F. Light microscopic image showing diffuse infiltration of marginal zone lymphocytes with mass formation beneath bronchial epithelium and rounded groups of small- to medium-sized lymphoid cells (Hematoxylin-Eosin stain; 40 × magnification in E; 100 × magnification in F). One month after radiotherapy, endobronchial mass disappeared (not shown).

• 

  Fig. 2 Endotracheal marginal zone B-cell lymphoma of BALT in trachea of 21-year-old woman (patient 5 in Table 1). A. Nonenhanced axial CT image obtained at level of thoracic inlet showing polypoid nodule on left side of middle trachea. B. Flexible fiberoptic bronchoscopy demonstrating nodular lesion with same smooth mucosal surface in trachea.

• 

  Fig. 3 Tracheobronchial marginal zone B-cell lymphoma of BALT in trachea and main stem bronchi of 42-year-old woman who presented with upper respiratory infection symptoms, including cough and sputum for 10 days (patient 2 in Table 1). A, B. Nonenhanced transverse CT images obtained at level of aortic arch showing multiple, discontinuous, small nodular lesions along inner wall of trachea and left main bronchus. C. Flexible fiberoptic bronchoscopy demonstrating multiple, small nodular mucosal lesions with cobblestone appearance along trachea. D, E. Light microscopic image showing diffuse infiltrates of lymphoid cells within mucosa. Normal germinal center, mantle zone, and marginal zone are not shown (Hematoxylin-Eosin stain; 40 × magnification in D; 100 × magnification in E).

• 

  Fig. 4 Tracheobronchial marginal zone B-cell lymphoma of BALT in 54-year-old woman (patient 1 in Table 1). A, B. Enhanced transverse CT images (5-mm-thick sections) obtained at level of carina and main bronchi showing diffuse and smooth wall thickening with homogeneous attenuation of carina and both main stem bronchi.

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