Bronchus-associated Lymphoid Tissue Lymphoma Research Articles

Extranodal marginal zone non Hodgkin's lymphoma of the lung: A ten-year experience

Bronchus-associated lymphoid tissue (BALT) lymphoma is a rare subtype of low grade marginal zone B cell lymphoma representing 10% of all MALT lymphomas. The purpose of this study was to analyze the outcome of this group of patients comparing prognostic parameters and therapy modalities. A total of eight patients with BALT lymphoma had diagnosed between January 1998-April 2008 at the Institute of Hematology, Clinical Center of Serbia, Belgrade, and they were included in this retrospective analysis. Male/female ratio was 2/6, the median age was 64 years (range 37-67 years). Six patients had nonspecific respiratory symptoms and all of them had B symptoms. The patients were seronegative for HIV, HCV and HBsAg. Three patients had Sjogren's syndrome, rheumatoid arthritis and pulmonary tuberculosis, respectively. Seven patients were diagnosed by transbronchial biopsy and an open lung biopsy was done in one patient. Patohistological findings revealed lymphoma of marginal zone B cell lymphoma: CD20+/CD10-/CD5-/CyclinD1/CD23-/IgM- with Ki-67+< 20% of all cells. According to the Ferraro staging system, five patients had localized disease (CS I-IIE) and three had stage IVE; bulky tumor mass had 3 patients. All patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1. Five patients received monochemotherapy with chlorambucil and 3 were treated with CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone). A complete response (CR) was achieved in 5 patients and a partial response (PR) in 3 of them, treated with chlorambucil monotherapy and CHOP regimen. All patients were alive during a median follow-up period of 49 months (range 6-110 months). Three patients relapsed after monochemotherapy into the other extranodal localization. They were treated with CHOP regimen and remained in stable PR. CONCLUSION. BALT lymphoma tends to be localised disease at the time of diagnosis, responds well to monochemotherapy with chlorambucil and has a favourable prognosis.

B-cell lymphoma of bronchus-associated lymphoid tissue: A rare lymphoma of lung

B-cell lymphoma of bronchus-associated lymphoid tissue: A rare lymphoma of lung

Pulmonary BALT Lymphoma Successfully Treated with Eight Cycles Weekly Rituximab: Report of First Case and F-18 FDG PET/CT Images

Extra marginal-zone lymphomas of the lung is a very rare tumor and it originates from bronchial-associated lymphoid tissue. A 68-yr-old woman presented with productive cough and dyspnea. A thorax computed tomography scan showed a 9 × 10 cm in size mass in the left lung and pleural effusion in the lower lobe of left lung. Positron emission tomography/computed tomography (PET/CT) revealed intense uptake foci at the upper and middle sites of left lung and slight uptake foci at the mediastinal lymph nodes which showed malignant involvement. After bronchoscopic biopsy, the diagnosis of pulmonary bronchial-associated lymphoid tissue (BALT) lymphoma was confirmed. At the end of the eight cycles weekly rituximab treatment, complete response was obtained by PET/CT findings. It is concluded that extended rituximab schedule is more effective and it would be beneficial to investigate the use of PET/CT in the diagnosis and evaluating of the treatment response of pulmonary BALT lymphoma.

Primary Bronchus-Associated Lymphoid Tissue (BALT) Lymphoma

Primary Bronchus-Associated Lymphoid Tissue (BALT) Lymphoma Bronchus-associated lymphoid tissue (BALT) lymphoma is a rare extra-nodal marginal zone lymphoma representing 0.5% of lung tumours. In order to share experience in the management of BALT lymphoma, we report a well-investigated case with unusual features as complex familial oncologic history and synchronous benign thyroid disease. The patient was a 44-year-old woman with prolonged unspecific respiratory complaints. By computed tomography (CT), bilateral atelectasis-like pulmonary lesions were found in the 3rd, 5th, 6th and 8th segments of the right lung and in the 3rd segment of the left lung. We performed diagnostic video-assisted wedge resection of the 5th segment of right lung. Pathologic and immunohistochemical examination yielded the diagnosis of BALT lymphoma. After staging by bone marrow biopsy and abdominal CT, chemotherapy was recommended by the oncologic council.

A Rare Case of Bronchial-Associated Lymphoid Tissue Lymphoma With Bone Marrow Involvement

INTRODUCTION: Extra-nodal marginal B-cell lymphoma of bronchial associated lymphoid tissue (BALT) is a rare entity accounting for less than 1% all lymphomas. It is characterized by an often indolent course, in patients that are often asymptomatic, and is found many times incidentally on chest radiography. In most cases BALT lymphoma is localized to one lung or involves bilateral lungs. Optimal management of this malignancy is not clearly defined.

A case of B-cell lymphoma of Bronchus-Associated Lymphoid Tissue (BALTOMA) masquerading as an atypical interstitial pneumonia

A case of B-cell lymphoma of Bronchus-Associated Lymphoid Tissue (BALTOMA) masquerading as an atypical interstitial pneumonia

Bronchus-Associated Lymphoid Tissue Lymphomas

: Bronchus-associated Lymphoid Tissue (BALT) lymphomas are a rare type of extranodal marginal zone lymphomas. They comprise 1% of lymphomas and more than two-thirds of all primary non-Hodgkin lymphoma (NHL) of the lung. BALT lymphomas arise from the bronchus-associated lymphoid tissue. This report describes five cases of BALT lymphoma and discusses the pathogenesis, diagnosis, prognosis and treatment of BALT lymphomas. In our cohort of patients, patients were managed with surgery, watchful waiting, chemotherapy, immunotherapy, and chemoimmunotherapy. The outcomes are excellent and projected 5-year survival is 100%. BALT lymphomas are associated with chronic inflammation, and they are often asymptomatic. They have an indolent course and the survival outcome is excellent with different treatment modalities such as surgery, watchful waiting, radiotherapy, chemotherapy, immunotherapy or chemoimmunotherapy.

BALTOMA (BRONCHUS-ASSOCIATED LYMPHOID TISSUE LYMPHOMA) PRESENTING AS ENLARGING GROUND GLASS OPACITIES

INTRODUCTION: Bronchus-associated lymphoid tissue lymphoma (BALToma) is a rare, low grade marginal zone lymphoma of the lung. Histologically, BALToma is characterized by the aggregation of extranodal, monoclonal B- lymphoid cells near the bronchial epithelium. The radiographic appearance of BALToma is variable, ranging from well circumscribed nodules, to dense consolidations with air bronchograms. We report two patients with histories of marginal zone lymphoma, who underwent resection of enlarging ground glass opacities (GGOs) found to be BALTomas.

Clinicopathological Features of Patients with Bronchial-Associated Lymphoid Tissue Lymphoma

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type is the most frequent type of non-Hodgkin's lymphoma to primarily involve the lung. Pulmonary MALT lymphoma, also known as bronchial-associated lymphoid tissue (BALT) lymphoma, is a rare disease and the clinicopathological features have yet to be clearly elucidated. The present study retrospectively reviewed 13 patients (8 men, 5 women) with BALT lymphoma from 3 institutions between 1989 and 2007 to assess clinicopathological features. At diagnosis, the median age was 61.6 years (range, 37-80 years), and 11 patients were asymptomatic while 2 had non-specific pulmonary symptoms. Two patients had a history of Sjögren's syndrome. Computed tomography of the chest revealed bilateral disease in 7 patients, lung nodules in 8 patients and air space consolidation with or without air bronchogram in 5 patients. In all cases, disease was localized within the lung at the initial diagnosis. Of the 13 patients, 5 remain untreated, while 8 received various combinations of treatment (surgery alone in 6 patients, surgery plus chemotherapy in 1 patient, and radiotherapy alone in 1 patient). Twelve patients remained alive during the median follow-up of 31.3 months (range, 2-147 months), while 1 patient died from unknown causes. The present study indicates that BALT lymphoma tends to be limited to the lung on the initial diagnosis and responds well to local therapy such as surgery. Prognosis for this lymphoma tends to be indolent.

Marginal Zone B-Cell Lymphoma of Bronchus-Associated Lymphoid Tissue: Imaging Findings in 21 Patients

Marginal Zone B-Cell Lymphoma of Bronchus-Associated Lymphoid Tissue: Imaging Findings in 21 Patients

Cytology of bronchial associated lymphoid tissue lymphoma

A 69-year-old man sought medical care because of persistent cough. Imaging work up revealed multiple nodules involving both lungs. Fine needle aspiration biopsy (FNA) of the right lower lobe mass was performed and revealed atypical alveolar cells in a lymphoid background. The initial cytologic interpretation was "atypical alveolar cells, probably reactive." The patient underwent wedge resection of the right lower lobe. Intraoperative touch preparation revealed an atypical lymphoid proliferation. Histologic findings revealed multiple nodules of small and medium-sized lymphocytes replacing the lung parenchyma; lymphoepithelial lesions, and type II pneumocytes hyperplasia were also noted. Flow cytometry demonstrated the presence of a monoclonal B-cell population. A diagnosis of bronchial associated lymphoid tissue (BALT) lymphoma was established. The patient was treated with rituximab and was disease free 2 years after initial diagnosis.

Bronchus-associated lymphoid tissue lymphoma in a patient with primary Sjögren’s syndrome

Despite its infrequent occurrence, the possible development of lymphoma or lymphoid lung disease in patients with Sjögren's syndrome should always be borne in mind. We describe a case of bronchus-associated lymphoid tissue (BALT) lymphoma in a patient with Sjögren's syndrome that clearly exemplifies the wide-ranging problems of diagnosing, treating and following such patients. This difficulty is due to the fact that the clinical and radiological findings suggest interstitial lung disease, and histological assays are required for a correct diagnosis. A precise knowledge of the various histological and radiological patterns of lung involvement can aid patient management.

Successful immediate cryorecanalization of a simultaneous high-grade tracheal and bronchial stenosis as rare manifestations of bronchial-associated lymphoid tissue lymphoma

Endobronchial tumor obstruction of central airways causes severe limitations for the patient. For these conditions, an effective and safe bronchoscopic treatment modality is required to ameliorate obstructive symptoms. Most physicians use mechanical debulking by the rigid scope, but neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, argon plasma coagulation, and cryorecanalization are alternative techniques. The use of the flexible cryoprobe for immediate ablation of endoluminal tumors in lung cancer has been described earlier. This case reports for the first time the successful cryorecanalization of a combined severe tracheal and bronchial stenosis owing to bronchialassociated lymphoid tissue (BALT) lymphoma.

Marginal Zone B-Cell Lymphoma of Bronchus-Associated Lymphoid Tissue: Imaging Findings in 21 Patients

Few articles have been published on imaging findings of marginal zone B-cell lymphoma of bronchus-associated lymphoid tissue (BALT) of the lung. We present CT scan and 18F-fluorodeoxyglucose (FDG) PET scan findings of the disease. From March 1995 to February 2007, 21 pretreatment patients (male patients, 9; female patients, 12; age range, 35 to 76 years; mean [+/- SD] age, 54 +/- 10.4 years) were seen who had pathologic diagnoses of marginal zone B-cell lymphoma of BALT. After CT scans were reviewed searching for specific patterns and distribution of parenchymal lung lesions, patients were classified as having the following four different patterns: (1) single nodular or consolidative; (2) multiple nodular or areas of consolidation; (3) bronchiectasis and bronchiolitis; and (4) diffuse interstitial lung disease (DILD) patterns. In six patients, in whom PET/CT scanning was performed, the pattern and the extent of maximum standardized uptake values (mSUVs) of FDG uptake were described. A single nodular or consolidative pattern was observed in 7 of 21 (33%) patients, multiple nodular or areas of consolidation were observed in 9 patients (43%), bronchiectasis and bronchiolitis were observed in 3 patients (14%), and DILD was observed in 2 patients (10%). On PET scans (n = 6), lesions showed heterogeneous FDG uptake in five patients and homogeneous uptake in one patient, with mSUVs ranging from 2.2 to 6.3 (mean mSUV, 4.2 +/- 1.48). Marginal zone B-cell lymphomas of BALT manifest diverse patterns of lung abnormality on CT scans, but single or multiple nodules or areas of consolidation are the main patterns that occur in a majority (76%) of patients. Most lesions show heterogeneous but identifiable FDG uptake on PET scans.

Pulmonary marginal zone lymphoma: A single centre experience and review of the SEER database

Pulmonary marginal zone lymphoma is a rare disease arising from bronchial-associated lymphoid tissue (BALT). There is limited information on clinical presentation, natural history and treatment of this type of lymphoma. We conducted a retrospective review of patients with biopsy-proven BALT lymphoma treated at our institution and patients from the surveillance epidemiology and end results (SEER) database. Twenty-one patients (median age 57) with disease stage IE (n = 10) and IV (n = 11), were treated at our institution. Initial management included observation (n = 4), surgery (n = 5), combination chemotherapy (n = 7), single-agent rituximab (n = 3) and radioimmunotherapy (n = 2). Complete remission was observed in 10, partial remission in 3, stable disease in 7, and disease progression in 1 patient. With a median follow-up of 20 months, Kaplan–Meier estimates for progression-free and overall survival (OS) at 80 months were 90% and 95%, respectively. We identified 326 patients (59% females and 41% males; median age 68 [30 to 85) with BALT lymphoma in the SEER database. Fifty-five per cent had stage IE, 10% stage IIE, 3% stage IIIE, and 22% stage IV disease. After a median follow-up of 35 months, median OS was 112 months, and disease-specific median survival was not reached. At 90 months, disease-specific survival was 85% (CI 77-92) with no significant differences in outcome between patients presenting with different stages. Our single institution experience and review of the SEER database, confirm the indolent features and favourable outcome of this rare disease.

Linfoma do tecido linfóide associado ao brônquio com evolução fatal

Primary pulmonary lymphoma is rare. The most common histological type is the bronchus-associated lymphoid tissue lymphoma. This type of lymphoma has an indolent course and excellent response to therapy. One-third of all cases are diagnosed incidentally. However, due to the rarity of this disease, little is known about its natural history in terms of dissemination and evolution. Herein, we report the unusual case of a 61-year-old man who refused treatment after being diagnosed with bronchus-associated lymphoid tissue lymphoma and died 2 years later from massive lung infiltration without dissemination to other organs.

A patient with endobronchial BALT lymphoma successfully treated with radiotherapy

Low-grade bronchus-associated lymphoid tissue (BALT) lymphoma is a rare tumour originating from the marginal zone of lymphoid tissue. It is a subgroup of B-cell extranodal non-Hodgkin's lymphoma with an indolent course. We report a case of this tumour with characteristic histologic feature. The patient had non-specific respiratory complaints. The tumour occluded the right bronchus intermedius. He received radiation therapy alone, resulting in complete remission of the tumour and disappearance of symptoms.

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

BALT(bronchial associated lymphoid tissue) lymphomas are a dist inct 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 inc identally on a routine chest radiograph. A 50-year-old man was admitted for an the evaluation of cough, dyspnea and fe ver. 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 H is pulmonary lesion was confirmed histologically to be a BALT(bronchial associated lymphoid tissue) lymphoma. We repor t a case of a BALT lymphoma, which was initially misdiagnosed as lipoid pneumonia. (Tuberc Respir Dis 2007; 63: 194-199)Key Words: BALT lymphoma, Marginal zone lymphoma, Non-Hodgikin's lymphoma , Lipoid pneumonia.Address for correspondence: Seung Soo Sheen, M.D.Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Wonchon-dong, Suwon, 443-721, KoreaPhone: 82-31-219-5122, Fax: 82-31-219-5124E-mail: sssheen@ajou.ac.krReceived: Jun. 14. 2007Accepted: Aug. 6. 2007

A Case of Bronchus-Associated Lymphoid Tissue(BALT) Lymphoma Treated with Lobectomy

The bronchus-asociated lymphoid tissue(BALT) lymphoma is a low-grade primary malignant lymphoma that originates from bronchus associated lymphoid tissue. A 67-year-old woman was admitted for evaluation of cough, sputum, rhinorrhea which had persisted for one month. Physical examination showed decreased breathing sound on the left upper lung field. High resolution chest computed tomography demonstrated consolidation which showed air-bronchogram and surrounding ground glass opacity in left upper lobe. These findings implicated inactive tuberculosis, organizing pneumonia, or bronchiolo-alveolar carcinoma. The histologic findings from percutaneous needle aspiration biopsy revealed aggregated atypical small lymphoid cells with lymphoepithelial lesions. With immunohistochemical staining, the atypical lymphoid cells reacted positively with CD 20 antibody and negatively with CD 3 antibody. Thus, we could diagnosed her as a patient with BALT lymphoma. After left upper lobectomy, she has been well without recurrence of the disease for 14 months. In this country of Republic of Korea, it was the 1st case of BALT lymphoma surgically treated when histological diagnosis had been done. Based on this case, we wanted to demonstrate the importance of early histological diagnosis and treatment of BALT lymphoma.

Bronchial-associated lymphoid tissue (BALT) lymphoma: a retrospective analysis

17547 Background: Systemic CT in BALT lymphoma is the accepted therapy for those pts where surgery isn’t radical or possible. There is not a standard systemic treatment for this uncommon lymphoma however its indolent behavior and the relative asymptomatic outcome, allows on systemic therapy delay and may justify the use of less toxic CT agents. Methods: Here we reported our experience on 19 pts (10 men and 9 women) with biopsy-proven BALT lymphoma, median age was 61 yrs; 8 pts presented a symptomatic disease at diagnosis. 15 pts had a localized pulmonary disease (stage IE); 4 pts had stage IVE disease for peripheral blood and bone marrow involvement (3 pts) and gastric involvement (1 pt). Of 16 pts valuable for response, 3 pts received radical surgery (1 wedge resection and 2 lobectomy) as definitive treatment and 13 pts received systemic treatment (Chl containing regimen in 6, Rituximab ± Chl in 6; CVP regimen in 1) because of symptomatic disease or relapse after major surgery. Results: 6/13 pts achieved CR: 5/6 are still alive and disease free: 1 pt in CR died for other causes. 3 pts in asymptomatic PR don’t need further therapy while the additional 4 pts in PR need subsequent treatment because of symptomatic progression after a median TTP of 40 months. With a median follow up of 39 months, the OS and RFS observed are 85% and 63% respectively. Hematology and non-hematology toxicity was in general mild: transient G3 neutropenia occurred in only two pts; no pt discontinued the treatment because of treatment-related toxicity and no toxic death was recorded. Conclusions: Our analysis seem to confirm that surgery could be considered as unique treatment only for minority of pts with BALT lymphoma. Systemic chemotherapy with Chl containing regimen may achieve a clinical control of disease with about 50% of CR as well as other reported with more aggressive CT regimen. A larger retrospective analysis on pathological figure and clinical outcome is planned on behalf of IELSG. No significant financial relationships to disclose.