Development of Bullous Disease during Treatment of Pulmonary Marginal Zone B-Cell Lymphoma

Sikandar Ansari ,Hala Dubaybo ,Edi Levi ,Basim A Dubaybo

doi:10.1155/2012/146081

Sikandar Ansari , Hala Dubaybo + Show 2 more

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https://doi.org/10.1155/2012/146081

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Abstract

We describe an unusual case of severe pulmonary bullous disease developing during treatment of marginal zone B-Cell lymphoma (MALT) involving the pulmonary parenchyma. The patient originally presented with pneumonia-like symptoms along with hemoptysis and was diagnosed with MALT lymphoma after a video-assisted thoracic surgical (VATS) lung biopsy. Computed tomography (CT) of the chest at diagnosis revealed multiple opacities, but no bullous disease. During the ensuing 4 years, and while on chemotherapy for the MALT lymphoma, sequential CT and pulmonary function tests revealed the development of progressive bullous disease resulting in the replacement of large portions of the lung parenchyma with bilateral bullae. This complication is rare, has been reported only once before in a patient with concomitant amyloidosis, and may be related to activation of proteolytic enzymes by lymphoma cells or chemotherapeutic agents.

Highlights

Marginal zone B-cell lymphoma (MALT) is a form of extranodal non-Hodgkin’s lymphoma reported in several organs including thymus [1], salivary glands [2], stomach [3], and small intestines [4]
A lung biopsy through a video assisted thoracic surgery (VATS) procedure was performed and the results showed MALT lymphoma (Figure 1)
It was not until he had hemoptysis that lung tissue biopsy was obtained resulting in the diagnosis of MALT lymphoma

Summary

Introduction

Marginal zone B-cell lymphoma (MALT) is a form of extranodal non-Hodgkin’s lymphoma reported in several organs including thymus [1], salivary glands [2], stomach [3], and small intestines [4]. MALT cells, produce proteases [6] that can potentially result in emphysematous lung injury and formation of bullae. This case demonstrates the development of bullous disease in a patient with pulmonary MALT. In 2001, the patient developed symptoms of pneumonia, and a computed chest tomography (CT) revealed nonspecific opacities in all lobes suggestive of bilateral consolidative process (The films from this CT were archived and could not be reviewed by the authors).

Results

Conclusion