Retrospective Analysis of 9 Cases of Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma and Literature Review

Comprehensive analysis of imaging and pathological features in 20 cases of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma: a retrospective study

Background

Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare, indolent subtype of non-Hodgkin lymphoma with distinct radiological and pathological characteristics. Clinically, patients may present with nonspecific symptoms such as cough or dyspnea, and the disease can mimic other pulmonary conditions. High-resolution computed tomography (HRCT) imaging plays a critical role in identifying characteristic lung patterns, such as nodules, consolidation, or ground-glass opacities, which help in differentiating pulmonary MALT lymphoma from other pulmonary disorders. The study aimed to identify clinical characteristics based on the HRCT imaging features and pathological findings in patients with pulmonary MALT lymphoma.

Methods

The retrospective study involved 20 confirmed cases of pulmonary MALT lymphoma from a thoracic specialty hospital. Comprehensive data analysis included HRCT imaging characteristics such as tumor size, location, bronchial changes and peritumoral pulmonary interstitial infiltration, as well as pathological features, including cell type, morphology, and immunohistochemistry.

Results

HRCT imaging showed a high prevalence of air bronchogram (100%) and bronchiectasis (85%), with tumors predominantly located in the left upper lobe. Pathologically, tumors predominantly exhibited monocytoid and centrocyte-like cells, minimal atypia, and B-cell markers like CD20 and CD3 expression. Surgical resection was the primary treatment modality in 60% of cases, with the rest receiving chemical treatment.

Conclusions

Significant features evident in both HRCT imaging and pathological analysis were identified in pulmonary MALT lymphoma cases. These findings are anticipated to play a crucial role in facilitating early diagnosis and determining optimal treatment strategies.

Primary pulmonary lymphoma: a surgical series

Primary pulmonary lymphoma (PPL) is a rare entity often underdiagnosed due to its non-specific clinical presentation. Our aim is to share our experience in the management of these lesions, which should be considered in the differential diagnosis of nodules affecting the lung parenchyma. We retrospectively studied a total of 14 patients who had undergone surgery between 2013 and 2021. We recorded pre- and post-operative information and conducted survival analyses. Of the 14 patients, seven were males. The mean age was 61.5. Most patients were asymptomatic. PPL presented predominantly as nodules or solid masses (71.4%), followed by consolidations with a pneumonia pattern and ground-glass nodule, with a median uptake on peak standardised uptake value (SUV) positron emission computed tomography of 5.7 mg/m2. There were nine cases (64.3%) of mucosa-associated lymphoid tissue lymphoma (MALT), four cases of diffuse large B cell lymphoma (28.6%) and one case of follicular B cell lymphoma. Fifty percent received adjuvant chemotherapy. Only one patient had disease progression. After a median follow-up of 38.6 months, 11 patients (78.6%) were still alive and disease-free. The overall 5-year survival was 92.9%. In conclusion, the most frequent PPL is the MALT type. Surgery seems to play a key role in diagnosis and treatment.

[Research Progress of Pulmonary Extranodal Marginal Zone Lymphoma]

Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common primary pulmonary lymphoma, which is an indolent B-cell lymphoma thought to originate from marginal zone B cells. Its pathophysiology is closely related to chronic antigenic stimulation, regardless of whether the antigens are auto-antigens or of microbial origin. Due to its nonspecific clinical presentation and low prevalence, pulmonary MALT lymphoma is often misdiagnosed. The disease is slow-growing, and different treatments have shown good efficacy, but its optimal treatment is somewhat controversial. This paper reviews the epidemiology, pathogenesis, clinical manifestations, computed tomography (CT) features, pathological diagnosis, treatment and prognosis of pulmonary MALT lymphoma, providing reference for clinicians to further understanding of the disease.
.

A Rare Case of Primary Pulmonary Diffuse Large B-Cell Lymphoma Transformed from Marginal Zone Mucosa-Associated Lymphoid Tissue Lymphoma

Primary pulmonary lymphoma is a rare neoplasm characterized by the proliferation of lymphoid tissue affecting the lungs. The most common subtype is marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). Rarely, a MALT lymphoma transforms into a diffuse large B-cell lymphoma (DLBCL). Treatment options include chemotherapy, radiotherapy, immunotherapy, and surgery. Here, we describe a patient with a primary pulmonary MALT lymphoma transforming into DLBCL. The purpose of this case report is to raise awareness of the relevant clinical and imaging features and to emphasize the need for a multidisciplinary approach to optimal management. In addition, we screened the PubMed and Embase databases for similar reports with a confirmed presence of transforming lymphoma within the lungs.

Clinical Analysis of 50 Cases of Primary Pulmonary Lymphoma: A Retrospective Study and Literature Review

Objective: This study aimed at to raise the awareness understanding of primary pulmonary lymphoma (PPL) by analyzing the clinical manifestation, imaging, pathology, diagnosis, treatment, and prognostic features of 50 cases of PPL. Methods: The study of 50 individuals with PPL diagnosed at the First affiliated hospital of Nanchang university between January 2009 and December 2019 was performed. Results: Overall, 27 males and 23 females were enrolled, with an average age of 57.6 ± 15.6 years. The primary symptoms included, cough (n = 37), expectoration (n = 25), sputum with blood (n = 12), and chest pain (n = 12). Two individuals had Hodgkin's lymphoma and 48 patients had non-Hodgkin's lymphoma (NHL). We divided the NHL cases into mucosa-associated lymphoid tissue lymphoma (MALT) (n = 21), diffuse large B-cell lymphoma (n = 12), small lymphocytic lymphoma (n = 2), mantle B-cell lymphoma (n = 2), follicular lymphoma (n = 1), B-cell lymphoma without further classification (n = 8), and T-cell lymphoma (n = 2). The imaging findings revealed that unilateral lung involvement was more common among the patients. The longest follow-up duration up to December 2019 was 123 months with 40 surviving patients. The 5-year overall survival and progression-free survival were 46.7% and 44.4%, respectively. Age was an independent predictive factor for the 5-year survival (hazard ratio, 8.900; P = .038), (P < .05). Conclusion: PPL is a uncommon disease with atypical clinical manifestations and is often misdiagnosed. Immunohistochemistry is currently the standard used in pathologic evaluation of PPL. MALT prognosis is better in contrast with other kinds of PPL. Surgery or radiotherapy can be considered in patients with limited lesions, and chemotherapy is the first treatment option for diffuse lesions. Age of ≥ 60 years was reported as an independent adverse predictive factor.

Two rare cases of bronchus-associated lymphoid tissue lymphoma successfully treated with rituximab-bendamustine

BALT lymphoma is a rare B-NHL with a favorable prognosis. We here report on two patients with nonspecific symptoms: one showed as major symptom severe thrombocytopenia and the other dyspnea and dry cough, thereby suggesting an inflammatory focus in the lungs. There is no standard of care established yet. Both patients were successfully treated with rituximab and bendamustine. Thus, combined immunochemotherapy should be considered as first-line therapy as in other MALT lymphomas, if the treatment/eradication of an underlying chronic inflammatory disorder/trigger factor can be excluded.

Maltoma veiled in the lung-a rare case of pulmonary and gastric maltoma

Mucosa associated lymphoid tissue (MALT) is a type of B-cell lymphoma that is commonly observed in the gastrointestinal site, most frequently occurring in the stomach. However, the incidence of this type of lymphoma in the respiratory tract is very uncommon. We report a case of this rare clinical entity in a patient who presented with non-symptomatology and was diagnosed with pulmonary MALT lymphoma (pMALToma).

Watch-and-wait or immediate immunotherapy/immunochemotherapy in patients with phase IE primary pulmonary MALT lymphoma? A multicenter retrospective study

Primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is rare, and the optimal frontline treatment has not taken shape so far. It is still debatable whether the watch-and-wait (W&W) policy is beneficial to patients, especially in the early stage. This study was to compare the efficacy of W&W with rituximab single agent or combined chemotherapy (R/R-Chemo) on primary pulmonary MALT patients with localized disease. Clinical characters and effect on 28 patients with primary pulmonary MALT (IE phase) were analyzed. Among the 28 patients, 14 were grouped into W&W cohort, and 14 were immediately treated with R/R-Chemo. The median follow-up duration was 62 months. The estimated median time to treatment failure (TTF) in the W&W cohort and immediate R/R-Chemo cohort was 29 months and 59 months, which were not significantly different (P = 0.667). The estimated median time of overall survival (OS) in the W&W cohort and immediate R/R-Chemo cohort was 78 months and 76 months, which were also not statistically significant (P = 0.696). Concerning prognosis, there is no difference between patients with primary pulmonary MALT (IE phase) treated with W&W and with timely R/R-Chemo.