Abstracts on Primary Pulmonary lymphomas

1: Jpn J Clin Oncol. 2004 Sep;34(9):510-4.

Primary pulmonary non-Hodgkin's lymphoma.

Kim JH, Lee SH, Park J, Kim HY, Lee SI, Park JO, Kim K, Kim WS, Jung CW, Park YS, Im YH, Kang WK, Lee MH, Park K, Han JH, Ko YH.

Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 135-710 Seoul, Korea.

BACKGROUND: Primary pulmonary non-Hodgkin's lymphoma is a very rare neoplasm. It is represented most commonly by marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. Although there have been a few reviews of this lymphoma, clinical features, diagnostic procedure, optimal management and prognostic factors have not been well defined. METHODS: We reviewed the medical records of 24 patients who were pathologically and clinically diagnosed as primary pulmonary lymphoma between September 1995 and June 2003. RESULTS: There were 13 patients with MALT lymphoma and two with MALT lymphoma accompanied by large B-cell lymphoma, seven with diffuse large B-cell lymphoma and two with anaplastic large cell lymphoma. Half the patients were asymptomatic at presentation; 46% had respiratory symptoms and 16.7% had B-symptoms. Initial radiological findings were variable including nodules, masses, infiltrates or consolidation. The majority of patients (66.7%) needed surgical approaches (open thoracotomy or video-assisted thoracoscopy) for definite diagnosis. Bronchoscopy was performed in 83%, but only 30% showed a diagnostic yield. The 13 patients with MALT lymphoma were treated with a variety of modalities such as observation, surgery and single or combination chemotherapy, and combination chemotherapy was administered to 11 patients with non-MALT lymphoma regardless of surgery. The overall survival rate at 3 years for all 24 patients was 86% with a median follow-up of 32 months. CONCLUSION: Although this entity of lymphoma appears to have a good prognosis, further clinical experience and long-term follow-up are needed to identify prognostic factors.

2: Eur J Cancer. 2004 Jun;40(9):1320-6.

Bronchial-associated lymphoid tissue lymphoma: a clinical study of a rare disease.

Ahmed S, Kussick SJ, Siddiqui AK, Bhuiya TA, Khan A, Sarewitz S, Steinberg H, Sison CP, Rai KR.

Saskatoon Cancer Center, University of Saskatchewan Campus, 20 Campus Drive, Saskatoon, SK, Canada S7N4 H4. sahmed@scf.sk.ca

Bronchial-associated lymphoid tissue (BALT) lymphoma is a distinct subgroup of low-grade B-cell extranodal non-Hodgkin's lymphoma, classified as marginal-zone lymphoma. This study was performed in order to assess the natural history of this rare entity. We evaluated retrospectively the clinical data of 22 patients with biopsy-proven BALT lymphoma at two tertiary-care institutions from 1996 to 2002. Immunophenotyping was done to confirm the abnormal populations of B-lymphoid cells in all cases, and clonality was determined by flow cytometry or molecular studies. There were 11 men and 11 women in the sample, median age 61 years (range 21-80 years); nine were asymptomatic at diagnosis. All 13 symptomatic patients had non-specific pulmonary complaints. On computed tomographic examination of the chest, 11 patients had bilateral disease, 12 had lung nodules, and 10 had a mass or air-space consolidation. In all but one case the disease was localised to the lung at diagnosis and none had peripheral blood or bone marrow involvement. Out of 22 patients, 20 received treatment in various combinations, 12 had chemotherapy and/or rituximab, six had surgery, and two received radiation therapy as primary treatment. A complete response (CR) was achieved in nine patients and a partial response was obtained in 10 patients. Seven of 10 patients who had unilateral disease achieved a CR. The estimated progression-free survival was 53 months. All patients were alive during the median follow-up period of 36 months (range 12-76 months). It appears that BALT lymphoma tends to be localised to lung at the time of diagnosis, responds well to local or systemic therapy, and has a favourable prognosis.

3: Kyobu Geka. 2004 Mar;57(3):249-52.

Mucosa-associated lymphoid tissue (MALT) lymphoma of the lung; report of a case

Otani S, Kawai T, Higashi R, Yamadori I.

Department of Thoracic Surgery, National Okayama Medical Center, Okayama, Japan.

We experienced a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the lung. The patient was 50-year-old woman. She had been pointed out a lung abnormal shadow on chest X-ray. A lung biopsy by a bronchofiberscope failed to diagnose, and an open lung biopsy under video-assisted thoracoscopic surgery (VATS) offered diagnosis as a MALT lymphoma. We performed the tumor resection (a upper-middle lobectomy of the right lung with hilar and mediastinal lymph node dissection under VATS). The post-operative course of the patient was uneventful and she has been free from the disease until now. MALT lymphoma has been a comparatively rare disease, but once the curative resection is performed the prognosis of the disease is good.

4: Kyobu Geka. 2004 Jan;57(1):75-9.

Mucosa-associated lymphoid tissue lymphoma; report of two cases

Toishi M, Miyazawa M, Takahashi K, Hyogotani A, Haba Y, Kato K, Muramatsu A,Nishiyama M, Ozawa K, Nanbu A, Miyata K.

Department of Surgery, Kofu Municipal Hospital, Kofu, Japan.

Primary pulmonary malignant lymphoma is a rare disease that is thought to belong to a category of malignant lymphomas arising from mucosa-associated lymphoid tissue (MALT). We presented 2 cases of MALT lymphoma. Case 1: In a 39-year-old woman, an abnormal shadow was detected in chest radiography in the left S3. The diagnosis was organizing pneumonia in consequence of the further examination. One year after an growing abnormal shadow was detected again, we performed the tumor resection with the thoracoscopy in the possibility of malignancy. The pathological diagnosis was MALT lymphoma. Case 2: In a 70-year-old man, middle lobe syndrome was detected in chest radiography. As a result of the bronchial biopsy, the lesion was suspected of MALT lymphoma. Right middle lobectomy was performed, and the tumor was diagnosed as a MALT lymphoma histologically. He underwent an effective postoperative radiotherapy and has had no evidence of recurrence.

5: Nihon Kokyuki Gakkai Zasshi. 2003 Dec;41(12):922-7.

A case of primary pulmonary MALT lymphoma as a nodular shadow on CT scan, and relapsed with diffuse micronodular shadows after surgical resection at 7 years ago

Kuroishi S, Nakano Y, Ono T, Shirai M, Hayakawa H, Murakami M, Suda T, Chida K, Nakamura H, Kobashi Y.

Department of Respiratory Medicine, National Tenryu Hospital, 4201-2 Oro, Hamakita, Shizuoka, 434-8511, Japan.

A 76-year-old man without symptoms was admitted to our hospital for investigation of an abnormal chest shadow in 1994. His chest radiograph showed a nodular shadow in the lingual lobe. Segmentectomy was performed and thehistological diagnosis was MALT (mucosa-associated lymphoid tissue) lymphoma. In June 2001, there were no abnormal shadows on the chest radiograph or in 10 mm slice CT. However, high-resolution CT with 2-mm slice thickness revealed diffuse micronodular shadows in both lungs. A relapse of MALT lymphoma was diagnosed by immunohistochemical analysis of tissue specimens obtained by transbronchial lung biopsy. It was observed that the patterns of radiological findings in primary pulmonary MALT lymphoma cases may differ between the initial state and a relapse.

6: An Med Interna. 2003 Nov;20(11):582-4.

Fluctuant pulmonary nodules as presentation of a MALT lymphoma

Dolz Aspas R, Toyas Miazza C, Ruiz Ruiz F, Morales Rull JL, Perez Calvo JI.

Servicio de Medicina Interna, Hospital Clinico Lozano Blesa, Zaragoza.

Mucosa associated lymphoid tissue (MALT) lymphomas are a group of non- Hodgkin"s lymphomas of low malignancy degree. The most frequent location is the gastrointestinal tract. Its primary pulmonary presentation is unusual and heterogeneous from point of view radiological. Woman 61 years old with antecedents of vitiligo, gastric ulcus, cirrhosis by VHC, that go into the hospital by sudden disnea, thoracic paint with pleural characterises and fever of 38.5 degrees C, Her thorax radiography and thoracic TAC showed nodes that affect to different pulmonary lobes. The cytology by PAAF confirms their malignant nature. In subsequent radiological controls it was notice the nodels took away completely and returns in different pulmonary place in each recurrence. The presentation like fluctuant pulmonary nodes is exceptional in a MALT lymphoma. It was described a higher incidence of VHC infection and tumour. The evidence of chronic hepatitis by virus C disease, and local chronic inflammatory process as well as autoimmune disorders may be considerate like a factor that contribute to MALT lymphoma.

7: Leuk Lymphoma. 2003 May;44(5):821-4.

Extranodal marginal zone B-cell lymphoma of MALT-type of the lung: single-center experience with 12 patients.

Zinzani PL, Tani M, Gabriele A, Poletti V, Stefoni V, Alinari L, Musuraca G, Bonifazi F, Pileri S, Tura S, Baccarani M.

Institute of Hematology and Oncology L. e A. Seragnoli, University of Bologna, Bologna, Italy. plzinzo@med.unibo.it

The lung is a relatively rare site for mucosa-associated lymphoid tissue (MALT) lymphomas: we report the largest available single-center series of patients with this presentation. From August 1992 to October 2000, 12 patients with untreated primary low-grade MALT lymphoma of the lung were submitted either to chemotherapy alone (n = 8), surgery alone (n = 2) or surgery plus chemotherapy(n = 2). At diagnosis, 6 (50%) were asymptomatic and 6 (50%) had nonspecific pulmonary symptoms. The most common radiologic findings were a pulmonary infiltrate (7 cases) and a mass lesion (5 cases). Histological diagnosis was obtained with transbronchial lung biopsy/bronchoalveolar lavage (BAL) (6 cases), with transthoracic needle biopsy (1 case), or an open thoracotomy (5 cases). All patients had stage IE. All 12 (100%) achieved complete remission; 3 (25%) local recurrences were observed. The global 6-year survival rate was 100% with a relapse-free survival rate of 50%. In conclusion, these data underline the diagnostic utility of BAL and the therapeutic efficacy of a chemotherapeutic strategy based on regimens such as N-CVP in the context of localized MALT lymphoma of the lung.

8: Eur Respir J. 2002 Sep;20(3):750-62.

Primary pulmonary lymphoma.

Cadranel J, Wislez M, Antoine M.

Dept of Pneumology and Respiratory Intensive Care, Tenon Hospital, Paris, France. jacques.cadranel@tnn.ap-hop-paris.fr

Three distinct entities are now covered by the definition of primary pulmonary clonal lymphoid proliferation. The aim of this review is to describe the pathophysiological, diagnostic, prognostic and therapeutic aspects of these three entities. Low-grade pulmonary B-cell lymphoma is the most frequent form of primary pulmonary clonal lymphoid proliferation. It arises from mucosa-associated lymphoid tissue. It is usually indolent and appears in the form of a chronic alveolar opacity. The prognosis is excellent, but treatment is controversial (simple monitoring, surgery or single-agent chemotherapy).High-grade pulmonary B-cell lymphoma is far rarer and usually occurs in individuals with an underlying disorder (e.g. immunodeficiency). The prognosis is poor and therapeutic options depend on the underlying disorder. The inclusion of lymphomatoid granulomatosis in the definition of primary pulmonary lymphomas is controversial. The clonal nature of the proliferation is very rarely demonstrated and extrapulmonary involvement is frequent (upper airways, skin, kidneys, central nervous system, etc.). The prognosis is extremely variable, with some authors reporting complete remission with steroids and cyclophosphamide and others reporting failure of combination chemotherapy.