A Case of Pulmonary MALT Lymphoma Arising from Lymphocytic Interstitial Pneumonitis

Abstract

Pulmonary mucosa-associated lymphoid tissue-derived (MALT) lymphoma is a rare disease. This disorder is considered to be a model of antigen-driven lymphoma, which is driven either by autoantigens or by chronic inflammatory conditions. Low-grade B-cell MALT lymphoma may develop from a nonneoplastic pulmonary lymphoproliferative disorder, such as lymphocytic interstitial pneumonitis (LIP). A recent estimate predicts that less than 5% of LIP patients acquire malignant, low-grade, B-cell lymphoma. In Korea, there has been no previous report of malignant low-grade, B-cell lymphoma, acquired from LIP. Here, we present the case of a patient with LIP that developed into pulmonary MALT lymphoma, six years after diagnosis.

Keywords: Lung Diseases, Interstitial; Lymphoid Tissue; Lymphoma; Lymphoproliferative Disorders.

Figure 1

Initial radiographic findings. (A) Chest posterior-anterior shows multifocal peribronchial consolidations, involving both lungs. (B, C) There are diffuse bilateral ground-glass opacity with intralobular septal thickenings and condolidative lesion on a chest computed tomography scan. (D) A chest X-ray after 8 months steroid treatment.

Figure 2

Initial histopathological findings. (A) Video-associated thoracoscopic lung biopsy specimens from the left upper lobe revealed diffuse severe lymphoid cell infiltration with some plasma cells in the interstitium and alveolar walls (H&E stain, ×40). (B) Immunohistochemical examination revealed that the lymphoid cells were evenly admixed with B lymphocytes and T lymphocytes, which were immunoreactive for CD79a and (C) CD3 (B, ×400; C, ×400).

Figure 3

Radiographic findings of second episode. (A, B) Initial chest computed tomography (CT) scan revealed diffuse bilateral ground-glass opacity with fine reticulation, traction bronchiectasis and consolidative lesion. (C, D) A chest CT scan after 6 months of steroid treatment.

Figure 4

Radiographic findings of Third episode. (A, B) A chest computed tomography (CT) scan revealed diffuse peribronchial thickening, extensive consolidative lesion and nodular lesion of both lung field. (C, D) A chest CT scan after 3 cycle of CHOP chemotherapy. CHOP: cyclophosphamide, hydroxydaunorubicin (doxorubicin), Oncovin (vincristine), and prednisone.

Figure 5

Histopathological findings of third episode. (A) Histological examination of percutaneous lung needle biopsy specimens revealed marked infiltration of lymphoid cells (H&E stain, ×200). (B) Immunohistochemical examination revealed that the lymphoid cells were diffusely positive for the CD79a, B-cell marker, but (C) negative for Bcl6, (D) CD10 and MUM-1 (B~D, ×400).