Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 48, Num. 2, 2011, pp. 273-274

Indian Journal of Cancer, Vol. 48, No. 2, April-June, 2011, pp. 273-274

Letter to Editor

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

ML Wani, AM Dar, MA Bhat, I Irshad, Nayeem-ul-Hassan

Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India

Correspondence Address: M L Wani Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir India latifs_dr@yahoo.com

Code Number: cn11073

DOI: 10.4103/0019-509X.82905

Sir,

B-cell lymphoma of bronchus-associated lymphoid tissue (BALT) or BALTOMA may be defined as low-grade non-Hodgkin′s lymphoma presenting in the lung, either unilaterally or bilaterally and showing no evidence of involvement of other sites (other than hilar lymph nodes) at the time of presentation or in the following 3-month period.

A 15-year old boy was admitted to our institute in September 2009 with 6 months of history of cough, left-sided chest pain, and an episode of hemoptysis. On physical examination, there was decreased chest expansion on left side, dullness on percussion, decreased breath sounds on left side. Laboratory studies included hemoglobin 14 g/dl, total leukocyte count 9000 (PNL 58%, lymphocytes 32%, monocytes 9%, and eosinophil 1%). Erythrocyte sedimentation rate was normal. All biochemical tests were also normal. Radiological studies showed left lower lobe lesion with left lower lobe consolidation [Figure - 1]. Fiber optic bronchoscopy showed left lower lobe bronchus hyperanemia with edema without any endobronchial lesion. Histopathology of mucosal biopsy and bronchial aspiration were negative. The patient was taken for surgery and left lower lobectomy was done as whole of left lower lobe was diffusely involved. Histopathological examination reveals a typical monotonous lymphomatous proliferation around bronchioles. Lymphocytes were hyperchromatic, irregular nuclear membrane and scanty cytoplasm, features favoring low-grade bronchus-associated lymphoma (BALTOMA) [Figure - 2]. Immunohistochemical examination revealed that B cells were stained positive for CD20 and CD79. Epithelial markers were stained negative for cytokeratin and EMA, and T-cell markers were negative for CD3. These features confirmed the histopathological report of BALTOMA. The patient was transferred to medical oncology department were after proper staging chemotherapy was given. Patient showed good clinical response and is on follow up.

Bronchus-associated lymphoid tissue has been referred as normal constituents of human lung. ^[1] However, recent studies has questioned this concept suggesting that it may develop only after immunological stimulation. ^[2] Lymphoid proliferation may present as interstitial infiltration, peribronchial proliferation, or isolated masses. ^[3] Patients may have cough, chest pain, hemoptysis, and dyspnea. Symptoms of lymphoma such as fever, night sweats, and weight loss may be present. ^[4] Our patient had only pulmonary symptoms. In chest radiography, it may present as diffuse infiltrates, reticulonodular pattern, small or large nodules and even effusion. ^[5] BALTOMA can be diagnosed by transbronchial or transthoracic needle aspiration biopsy. ^[5] However, in central lesions and lesions were transthoracic and transbronchial biopsies are inconclusive open biopsy may be needed as was in our case, where open thoracotomy was the only remaining tool. We present a case of BALTOMA which was diagnosed by open lung biopsy with review of literature. The aim is to contribute to the diagnostic approach to be followed for such lesions. We recommend that BALTOMA should be included in differential diagnosis of a patient who develops slow growing pulmonary symptoms and consolidation.

References

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