An Unusual Presentation Of Pulmonary Mucosa-associated Lymphoid Tissue Lymphoma As Diffuse Pulmonary Infiltrates With Spontaneous Regression
Kang, H. S., Lee, H. Y., Kim, S. J., Kim, S. C., Kim, Y. K., Park, G. S., Lee, K. Y., Jung, J. I., & Kang, J. Y. (2015). An Unusual Presentation of pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma as Diffuse pulmonary Infiltrates with spontaneous Regression. Cancer research and treatment, 47(4), 943–948. https://doi.org/10.4143/cright.2014.016
View Original Source →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.
Case Details
Disease Location
Lung
Personal Characteristics
57 -year-old female
Clinical Characteristics
Pulmonary mucosa-associated lymphoid tissue lymphoma presented with complaints of cough, febrile sensation and dyspnea for 2 months chest x-ray and CT of the chest showed multifocal ground-glass opacities in both lower lobes with interlobular septal thickening there was a mild elevation of c-reactive protein (5.42mg/dl) and serum lactate dehydrogenase (498u/l) arterial blood gas analysis showed ph 7.478, pco2 32.6mm hg, po2 60.1mm hg, and sao2 91.1% while breathing ambient air, antibiotics were given she underwent a bronchoscopy, and bronchoalveolar lavage fluid analysis showed a composition of 82% lymphocytes, 13% neutrophils, and 2% eosinophils microbiologic study showed acinetobacter baumannii follow-up chest CT after the antibiotics treatment 10 days later showed little interval change of the lung lesion diagnostic open lung biopsy via thoracoscopy was done at the lingular segment of the left upper lobe, histopathy demonstrated atypical lymphoproliferative lesion on hematoxylin and eosin stain, the atypical lymphocytes were positive for CD20 and CD3 ihc and pcr assay for igh gene showed monoclonality initially, lymphoid follicular hyperplasia was diagnosed pathologically after observing improvements, 2 months later fish analysis detected api2-malt1 at the level of 80.9% but not for malt1 rearrangement pulmonary malt lymphoma was confirmed in a staging workup including abdomen CT, PET/CT, esophagoduodenoscopy, and bone marrow biopsy there was involvement of malt lymphoma in the bone marrow she received chemotherapy
Remission Characteristics
Her symptoms and radiologic findings improved after open lung biopsy the at time of confirmed malt diagnosis, she did not complain of any symptoms and follow-up chest CT showed complete regression of the previous lung lesion at 3 months of treatment, follow-up bone marrow aspirate de monthstated no evidence of lymphoma
Treatment & Mechanisms
Proposed Remission Mechanisms
Anti-inflammatory effect of macrolide-induced apoptosis of lymphocytes via downregulation of overexpressed bcl-xl, anti-apoptotic gene, is suggested possibility that the chronic respiratory inflammation was controlled by antibiotics (even though the antibiotics were not macrolide)
Clinical Treatment
Ceftazidime and levoflaxacin (10 days) chemo (rituximab, cyclophsphamide, doxorubin, and vincristine)
Non-Clinical Treatment
None reported