Tuberc Respir Dis.  2007 May;62(5):427-431.

A Case of Bronchus-Associated Lymphoid Tissue(BALT) Lymphoma Treated with Lobectomy

• Choi WS
• Cho JH
• Hwang YI
• Jang SH
• Kim DG
• Jun SY
• Min K
• Lee IJ
• Lee JW
• Jung KS

Abstract

The bronchus-asociated lymphoid tissue(BALT) lymphoma is a low-grade primary malignant lymphoma that originates from bronchus associated lymphoid tissue. A 67-year-old woman was admitted for evaluation of cough, sputum, rhinorrhea which had persisted for one month. Physical examination showed decreased breathing sound on the left upper lung field. High resolution chest computed tomography demonstrated consolidation which showed air-bronchogram and surrounding ground glass opacity in left upper lobe. These findings implicated inactive tuberculosis, organizing pneumonia, or bronchiolo-alveolar carcinoma. The histologic findings from percutaneous needle aspiration biopsy revealed aggregated atypical small lymphoid cells with lymphoepithelial lesions. With immunohistochemical staining, the atypical lymphoid cells reacted positively with CD 20 antibody and negatively with CD 3 antibody. Thus, we could diagnosed her as a patient with BALT lymphoma. After left upper lobectomy, she has been well without recurrence of the disease for 14 months. In this country of Republic of Korea, it was the 1st case of BALT lymphoma surgically treated when histological diagnosis had been done. Based on this case, we wanted to demonstrate the importance of early histological diagnosis and treatment of BALT lymphoma.

Keyword

BALT; Lung; Mucossa-associated lymphoid tissue (MALT) lymphoma

MeSH Terms

Adenocarcinoma, Bronchiolo-Alveolar
Aged
Biopsy, Needle
Bronchi
Cough
Diagnosis
Female
Glass
Humans
Lung
Lymphocytes
Lymphoid Tissue
Lymphoma*
Needles
Physical Examination
Pneumonia
Recurrence
Republic of Korea
Respiratory Sounds
Sputum
Thorax
Tuberculosis

Figure

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  Figure 1A Consolidation combined with linear opacities was noted on left upper lobe.

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  Figure 1B HRCT demonstrated consolidation which showed air-bronchogram and surrounding ground glass opacity in left upper lobe and the lesion was mainly adjacent to pleura and fissure.

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  Figure 2 In gross appearance after operation, lesion demonstrated an irregular diffuse consolidation with a solid tan-colored cut surface abutting visceral pleura.

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  Figure 3 On 12 months After lobectomy, whole body PET CT did not demonstrate any evidence of local recurrence or distant metastasis of BALT lymphoma.

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  Figure 4 (A) Atypical lymphocytes with interstitial multinodular infiltration pattern and multiple foci of perivascular lymphoid infiltration ("lymphotic trackings", arrows) were seen. (H&E, ×100) (B) The tumor consisted of small lymphocytes which showed clear abundant cytoplasm. They grew in monotonous sheets and infiltrated to respiratory epithelial cells("lymphoepithelial lesion", arrows). (H&E, ×200) (C) Atypical lymphocytes reacted with CD 20 antibody positively (B cell maker). (immunohistochemistry, ×200) (D) Epithelial cells in the lymphoepithelial lesions reacted with cytokeratin positively . (immunohistochemistry, ×200)

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