A Case of Low-grade B-cell Lymphoma of Bronchial Associated Lymphoid Tissue Mimicking Lipoid Pneumonia

리포이드 폐렴(Lipoid pneumonia)으로 오인된 폐에 발생한 림프절 외 변연부 B-세포 림프종 1예

  • Cho, Jin Hee (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Yang, Min Jae (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Yu, Su Kyong (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Soe, Kyoung Woo (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Kim, Hugh Chul (Department of Hemato-oncology, Ajou University School of Medicine) ;
  • Sheen, Seung Soo (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine)
  • 조진희 (아주대학교 의과대학 호흡기 내과학교실) ;
  • 양민재 (아주대학교 의과대학 호흡기 내과학교실) ;
  • 유수경 (아주대학교 의과대학 호흡기 내과학교실) ;
  • 서경우 (아주대학교 의과대학 호흡기 내과학교실) ;
  • 김효철 (아주대학교 의과대학 종양혈액 내과학교실) ;
  • 신승수 (아주대학교 의과대학 호흡기 내과학교실)
  • Received : 2007.06.14
  • Accepted : 2007.08.06
  • Published : 2007.08.30

Abstract

BALT(bronchial associated lymphoid tissue) lymphomas are a distinct subgroup of low-grade B-cell extranodal non-Hodgkin's lymphoma, which are classified as a marginal-zone lymphomas. The majority of the patients are asymptomatic or their pulmonary lesions is often discovered incidentally on a routine chest radiograph. A 50-year-old man was admitted for an the evaluation of cough, dyspnea and fever. His chest CT showed ground glass appearance with interlobular septal thickening in both lower lobes, right middle lobe and left lingular division. He had been initially diagnosed with lipoid pneumonia and was kept under observation. However, his chest lesion showed continuous progression and a video-associated thoracoscopy was performed His pulmonary lesion was confirmed histologically to be a BALT(bronchial associated lymphoid tissue) lymphoma. We report a case of a BALT lymphoma, which was initially misdiagnosed as lipoid pneumonia.

기관에 발생한 림프절 외 변연부 B-세포 림프종(BALT lymphoma)은 폐에서 원발하는 비호지킨스 림프종의 70% 이상을 차지하지만 전체 림프종의 1% 미만을 차지할 만큼 드문 질환으로 흉부 단순 촬영에서 우연히 발견되는 경우가 많고, 예후는 비교적 양호하나 아직 확립된 치료법은 없는 상태이다. 저자들은 흉부 방사선 촬영 상 지속되는 폐침윤 소견을 주소로 내원 후 리포이드 폐렴으로 오인되어 진단과 치료가 늦어 골수 침범까지 진행된 폐에 발생한 림프절 외 변연부 B-세포 림프종을 1예를 경험하여 보고하는 바이다.

Keywords

References

  1. Zinzani PL, Magagnoli M, Galieni P, Martelli M, Poletti V, Zaja F, et al. Nongastrointestinal low-grade mucosa-associated lymphoid tissue lymphoma: analysis of 75 patients. J Clin Oncol 1999;17:1254
  2. Ahmed S, Kussick SJ, Siddiqui AK, Bhuiya TA, Khan A, Sarewitz S, et al. Bronchial-associated lymphoid tissue lymphoma: a clinical study of rare disease. Eur J Cancer 2004;40:1320-6 https://doi.org/10.1016/j.ejca.2004.02.006
  3. Hara S, Yokote T, aka S, Akioka T, Kobayashi K, Tsuji M, et al. Bronchial infiltration with diffuse large B-cell lymphoma. Leuk Res 2006;30:1319-22 https://doi.org/10.1016/j.leukres.2006.02.009
  4. Varoczy L, Gergely L, Illes A Diagnostics and treatment of pulmonary BALT lymphoma: a repert on four cases. Ann Hematol 2003;82:363-6 https://doi.org/10.1007/s00277-003-0658-5
  5. Kang MJ, Lee JM, Lee SJ, Son JW, Kim DG, Lee MG, et al. A case of Broncus-Associated Lymphoid Tissue lymphoma in the lung of the patient with primary Sjogren's Syndrome. Tuberc Respir Dis 2002;52: 179-85 https://doi.org/10.4046/trd.2002.52.2.179
  6. Kurtin PJ, Myers JL, Adlakha H, Strickler JG, whse C, Pankratz VS, et al. Pathologic and clinical features of primary pulmonary extranodal marginal zone B-cell lymphoma of MALT type. Am J Surg Pathol 2001;25: 997-1008 https://doi.org/10.1097/00000478-200108000-00003
  7. Isaacson P, Wright DH. Malignant lymphoma of mucosa associated lymphoid tissue. A distinctive type of B-cell lymphoma. Cancer 1983;52:1410-6 https://doi.org/10.1002/1097-0142(19831015)52:8<1410::AID-CNCR2820520813>3.0.CO;2-3
  8. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, et al. The WHO classification of neoplastic disease of hematopoietic and lymphoid tissue: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. Histopathology 2000;36:69-86 https://doi.org/10.1046/j.1365-2559.2000.00895.x
  9. Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, et al. A revised European-American Classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 1994;84:1361-92
  10. Matsushima AY, Hamele-bena D, Osborne BM. Fineneedle aspiration biopsy findings in marginal zone B cell lymphoma. Diagn Cytopathol 1999;20:190-8 https://doi.org/10.1002/(SICI)1097-0339(199904)20:4<190::AID-DC2>3.0.CO;2-E
  11. Ferraro P, Trastek VF, Adlakha H, Deschamps C, Allen MS, Pairolero PC. Primary non-Hodgkin's lymphoma of lung. Ann Thorac Surg 2000;69:993-7 https://doi.org/10.1016/S0003-4975(99)01535-0
  12. Takamori M, Noma S, Kobashi Y, Inoue T, Gohma I, Mino M, et al. CT findings of BALTDMA. Radiat Med 1999;17:349-54
  13. Ahmed S, Siddiqui AK, Rai KR Low-grade B-cell bronchial associated lymphoid tissue(BALT) lymphoma. Cancer Invest 2002;20:1059-68 https://doi.org/10.1081/CNV-120005924