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Cho, Jung, Cha, Park, Kim, Kim, Park, Woo, Eum, Lee, and Jegal: A Case Report of Disseminated Extranodal Marginal Zone B-Cell Lymphoma of MALT Manifested by Solitary Pulmonary Nodule
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 61(2): 171-177.

Published online: 31 August 2006

DOI: https://doi.org/10.4046/trd.2006.61.2.171

A Case Report of Disseminated Extranodal Marginal Zone B-Cell Lymphoma of MALT Manifested by Solitary Pulmonary Nodule

Joon Hyun Cho, M.D., Jong Pil Jung, M.D.1, Hee Jeong Cha, M.D.2, Chang Ryul Park, M.D.1, Sung Ryul Kim, M.D.3, Hawk Kim, M.D., Jin Woo Park, M.D., Soon Joo Woo, M.D., Eun A Eum, M.D., Ki Young Lee, M.D., Yang Jin Jegal, M.D.

Department of Internal Medicine, Ulsan University Hospital, Korea.

1Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, Korea.

2Department of Pathology, Ulsan University Hospital, Korea.

3Department of Laboratory Medicine, Ulsan University Hospital, Korea.

Address for correspondence: Yangjin Jegal, M.D. Department of Internal Medicine, Ulsan University Hopital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea. Phone: 052-250-8827 Fax: 052-251-8235, yjjegal@uuh.ulsan.kr

Received 18 April 2006       Accepted 23 June 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) is usually indolent. Although it was reported recently that about 20-30% cases of MALT lymphoma presented with a disseminated disease at diagnosis, it was described as a disease localized at diagnosis and remaining stable for a prolonged period. However, only a few cases of MALT lymphoma involved the lung and gastrointestinal tract all at once. We report a case of a 73-year-old man with disseminated MALT lymphoma. He presented with non-productive cough, initial chest radiograph showed a nodule in the right lower lobe.
The diagnosis of stage IV MALT lymphoma was made by CT scan, video-assisted thoracoscopic excisional biopy, gastrofiberscopic biopsy and bone marrow biopsy. The lymphoma involved the lung, stomach and bone marrow at the time of diagnosis. Because he refused chemotherapy, he discharged after Helicobacter pylori eradication without chemotherapy. Regular follow-up examination did not show any evidence of disease progression over 22 months.

Keywords: Extranodal marginal zone B-cell lymphoma of MALT, Disseminated, Solitary pulmonary nodule

Figures and Tables

Figure 1
Chest radiograph shows a nodule in the right lower lobe
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Figure 2
Chest CT scan shows a 3.3 × 1.7cm sized nodule with spiculated margin in anterior basal segment of right lower lobe.
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Figure 3
Gastrofibroscopy shows 2.0 and 1.5cm sized elevated, central depressed lesions with mucosal irregularity on the great curvature and lesser curvature of the lower body.
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Figure 4
Pathologic findings of the lung nodule (A) The neoplastic lymphoid cells efface pulmonary architecture (H&E × 40). (B) The extranodal marginal zone B cell lymphoma of MALT consists of centrocyte like cells, monocytoid cells and lymphoepithelial lesion (H&E × 100).
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Figure 5
Immunohistochemical stain of the lung nodule (A) The CK7 stain reveals lymphoepithelial lesion (× 100). (B) The stain for CD20 shows shows strong positive reaction in tumor cells (× 100).
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Figure 6
Pathologic findings of gastric mucosa. (A) It shows small to medium sized lymphocytes and lymphoepithelial lesion (H&E × 100). (B) Immunohistochemical stain for C79a shows positive reaction in tumor cells (× 100).
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Figure 7
A tiny nodular mass is seen at the section of bone marrow biopsy with H&E stain (× 100).
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Figure 8
Immunohistochemical stain of the bone marrow for CD20(A) & CD79a(B) shows strong positive reaction in tumor cells (× 100).
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