Pleuric presentation of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: a case report and a review of the literature

Pleural Marginal Zone Lymphoma Masquerading as Metastatic Adenocarcinoma of the Lung

Extranodal marginal zone lymphoma (EMZL) is a rare subtype of non-Hodgkin's lymphoma characterized by the malignant transformation of lymphoid tissue at sites affected by chronic inflammation. Pleural marginal zone lymphoma (PMZL) is an infrequent manifestation of this condition. We report a case of PMZL co-occurring with primary lung adenocarcinoma. This case involves an 88-year-old female patient who presented to the emergency department with recurrent pleural effusions and symptoms suggestive of decompensated heart failure. A thoracentesis of the effusion revealed an aspergillus population. Throughout her hospitalization, the patient underwent multiple evaluations for malignancy; however, no conclusive findings emerged. Ultimately, PMZL and poorly differentiated primary adenocarcinoma of the lung were confirmed through random biopsies of the parietal pleura and lung opacities, respectively. The pleural pathology showed a monoclonal population of immunoglobulin G kappa, positive for cluster of differentiation (CD) markers CD20 and CD43. Consequently, she was treated with rituximab for PMZL, with plans to address the adenocarcinoma through stereotactic body radiation therapy (SBRT). Unfortunately, due to deconditioning from multiple hospitalizations and a pulmonary embolism, the patient chose comfort measures and subsequently passed away. Diagnosing PMZL can be challenging due to the absence of identifiable nodules. Reported cases have similarly required extensive investigations to reach a final diagnosis. While a direct correlation between chronic inflammation, frequent infectious pathogens, and the development of PMZL has yet to be established, a known association exists between EMZL and pathogens such as Helicobacter pylori in gastric involvement and Chlamydia psittaci in ocular adnexa. This report highlights the difficulties in obtaining a diagnosis for PMZL and examines the various mechanisms that may have contributed to this unusual finding.

Utilizing medical thoracoscopy for the diagnosis of B-cell lymphoma presenting with pleural effusion: A case series

A third of patients with non-Hodgkin's lymphoma (NHL) develop pleural effusion during the disease course for various reasons. In most cases, lymphoma-related pleural effusion is a manifestation of widespread systemic disease, signifying a high tumour burden and therefore, a poorer prognosis. On the other hand, primary pleural lymphomas (PPLs) exhibit exclusive or dominant involvement of serous cavities, without detectable solid tumour masses. PPL is an uncommon disease and is of two types: primary effusion lymphoma (PEL) and diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI). PPLs not related to PELs and DLBCL-CIs are exceedingly rare. Herein, we describe four patients with biopsy proven B-cell NHL. One had no extra-pleural involvement at the time of diagnosis, indicating PPL. In all cases, histopathological examination of pleural biopsies obtained via medical thoracoscopy (MT) were crucial in clinching the final diagnosis. Clinicians are alerted to the potential relationship between exudative effusion and NHL as well as the role of MT in the diagnosis of B-cell NHL.

Roadside serendipity: an accident can lead to a rare diagnosis

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Primary Pleural Extranodal Marginal Zone Lymphoma Presenting as Bilateral Chylothorax

Here we describe a case of pleural extranodal marginal zone lymphoma presenting as bilateral chylothorax which has not been reported in the literature prior to this. Primary pleural lymphomas are a rare entity most commonly associated with chronic infections, autoimmune conditions or long-standing pyothorax which were not seen in this case. Chylous pleural effusions in this patient were successfully managed with chemotherapy for the underlying lymphoma.

Recurrence of Gastric Mucosa-associated Lymphoid Tissue Lymphoma in the Pleura: A Case Report

Mucosa-associated lymphoid tissue (MALT) lymphoma is classified as marginal zone lymphoma, a form of low-grade malignant B-cell non-Hodgkin's lymphoma. It affects the gastrointestinal tract with lung and pleural involvement considered to be rare. We describe a case of a 71-year-old man with a history of MALT lymphoma in remission who presented with dyspnea due to pleural effusion. Pleural fluid flowcytometry analysis showed monotypic B-cell population that expressed cluster of differentiation (CD)19, CD20, CD22, and kappa surface light chains. Medical pleuroscopy and pleural biopsy showed fibroadipose tissue with poorly defined lymphoid aggregates displaying a so-called "monocytoid" appearance, a histologic finding typical of marginal zone lymphoma. The patient underwent pleurodesis and achieved resolution of pleural effusion; however, the patient developed several complications and was discharged on home hospice.

Medical thoracoscopy in MALT lymphoma causing pleural effusion: A case report

Mucosa-associated lymphoid tissue (MALT) lymphoma is a form of low-grade malignant B-cell extranodal non-Hodgkin's lymphoma. It is classified as marginal-zone lymphoma and represents less than 1% of all lung cancer. We describe a case of MALT lymphoma limited exclusively to the lung that came to our attention with infective pleural effusion and concomitant lung consolidation of the left lower lobe. Our case demonstrates that MALT can begin with an acute clinical presentation. The clinical scenario, with fever, parietal chest pain, and leukocytosis, suggested an infective process. Radiological and sonographic examinations and the endoscopic aspect during medical thoracoscopy (MT) were typical of an infective etiology. The histological outcome of non-specific inflammatory pleuritis confirmed our suppositions. However, the missing resolution of lung consolidation after several weeks led us to an alternative diagnosis. Parenchymal biopsies obtained by bronchoscopy allowed us to reach the correct diagnosis: MALT lymphoma limited to the lung.

Case report. Primary mucosa-associated lymphoid tissue lymphoma as a pleural mass

Primary pleural lymphoma is a rare entity that has been described in association with human immunodeficiency virus (HIV) infection or pyothorax. It occurs in only 7% of primary lymphoma cases. We report the case of a 52-year-old male with no history of HIV infection or pyothorax who was diagnosed of obstructive sleep apnoea syndrome (OSAS) and underwent a routine chest X-ray to screen for any organic cause of the symptoms. The radiograph revealed two voluminous masses with extraparenchymatous features but without pleural effusion. A contrast-enhanced CT was performed and confirmed the existence of the pleural masses that showed homogeneous attenuation. Neither mediastinal lymphadenopathy nor pleural effusion were present. A percutaneous CT-guided fine needle aspiration cytology (FNAC) with a 25-G needle was performed (two samples were obtained) and the first diagnosis was of non-Hodgkin's lymphoma. The final diagnosis of primary pleural mucosa-associated lymphoid tissue (MALT) lymphoma was confirmed by a CT-guided core biopsy with a 20-G needle. To the best of our knowledge, no cases of MALT lymphoma presenting as pleural masses without pleural effusion have been reported in immunocompetent patients. In this report, we describe the case of a patient with a primary pleural MALT lymphoma and include a short review of the literature.

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type arising in the pleura with pleural fibrous plaques in a lathe worker

Our patient was an 86-year-old man who had worked as a lathe operator for 40 years. He had no history of tuberculosis, pyothorax, or autoimmune disease. He had not been exposed to asbestos. He was asymptomatic, but an imaging study showed gradually increasing pleural plaques. A biopsy specimen of a pleural lesion showed sclerosis of the pleura and diffuse infiltration of small- to medium-sized B lymphocytes. Polymerase chain reaction-based analysis detected monoclonal rearrangement of immunoglobulin heavy-chain genes. Histologic diagnosis was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma). The lymphoma was negative for Epstein-Barr virus. We report a rare case of a metal worker with MALT lymphoma arising in the pleura with pleural fibrous plaques. It is speculated that MALT lymphoma might develop in the background of pneumoconiosis. Inflammatory and/or immunologic reactions to metal particles might contribute to the oncogenesis of this tumor.