Cancer Res Treat.  2015 Oct;47(4):943-948. 10.4143/crt.2014.016.

An Unusual Presentation of Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma as Diffuse Pulmonary Infiltrates with Spontaneous Regression

• Kang HS
• Lee HY
• Kim SJ
• Kim SC
• Kim YK
• Park GS
• Lee KY
• Jung JI
• Kang JY

• KMID: 2403416
• DOI: http://doi.org/10.4143/crt.2014.016

Abstract

A 57-year-old woman presented with cough and dyspnea for 2 months. Computed tomography of the chest showed diffuse ground-glass opacities in both lungs. Histologic examination via thoracoscopic lung biopsy revealed atypical lymphoproliferative lesion. Her symptoms and radiologic findings of the chest improved just after lung biopsy without any treatment. Therefore, she was discharged and monitored at an outpatient clinic. Two months later, pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma was confirmed by the detection of API2-MALT1 translocation in fluorescent in situ hybridization analysis. Although the lung lesions resolved spontaneously, she received chemotherapy due to bone marrow involvement in her staging workup. Pulmonary MALT lymphoma is rare. Nodular or consolidative patterns are the most frequent radiologic findings. Although the disease has an indolent growth, it rarely resolves without treatment. We report an unusual case of pulmonary MALT lymphoma with diffuse interstitial abnormalities on image and spontaneous regression on clinical course.

Keyword

Marginal zone B-cell lymphoma; Lung; Spontaneous neoplasm regression

MeSH Terms

Ambulatory Care Facilities
Biopsy
Bone Marrow
Cough
Drug Therapy
Dyspnea
Female
Humans
In Situ Hybridization, Fluorescence
Lung
Lymphoid Tissue
Lymphoma
Lymphoma, B-Cell, Marginal Zone*
Middle Aged
Neoplasm Regression, Spontaneous
Thorax

Figure

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  Fig. 1. Chest X-ray (A) and chest computed tomography (CT) (C) showed multifocal patchy ground-glass opacities in both lungs with interlobular septal thickenings. Chest X-ray right after open lung biopsy demonstrated a resolved infiltration (B). Follow-up chest CT without treatment two months later presented near complete regression of the previously noted diffuse interstitial infiltrates in both lungs (D).

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  Fig. 2. H&E-stained sections of lung showed atypical lymphoproliferative lesion (A, ×200; B, ×400). Immunostains for CD20 (C, ×200) and CD3 (D, ×200) were expressed in the atypical lymphocyte population.

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  Fig. 3. Fluorescent in situ hybridization analysis using API2/MALT1 dual fusion translocation probe shows split signals. Cells possessing gene alterations are indicated with arrows.

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  Fig. 4. Bone marrow aspiration showed infiltration of neoplastic lymphoid cells in multinodular pattern (A, H&E staining, ×100; B, H&E staining, ×400). Immunohistochemical stain presented the lymphoid cells to be positive for CD20 (C, ×200). Three months after chemotherapy, immunohistochemical stains for CD20 (D, ×200) were negative.

Reference

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