Bronchus-Associated Lymphoid Tissue Lymphoma
| Autor: | Hernani Cualing, Gabriela Bedolla, Alena Goldman, Fadi Gebrail |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Pathology medicine.medical_specialty Lymphoma B-Cell Bronchi Respiratory Mucosa Bronchial brushing Pathology and Forensic Medicine Gross examination Humans Medicine Multiple Pulmonary Nodules business.industry Lymphoma Non-Hodgkin Nodule (medicine) General Medicine Gene rearrangement medicine.disease Lymphoma Medical Laboratory Technology Lymphatic system Female Differential diagnosis medicine.symptom Tomography X-Ray Computed business |
| Zdroj: | Archives of Pathology & Laboratory Medicine. 127:115-116 |
| ISSN: | 1543-2165 0003-9985 |
| DOI: | 10.5858/2003-127-115-balt |
| Popis: | 41-year-old white woman presented with nonspecific respiratory symptoms. The results of physical exam were nonrevealing; however, a computed tomographic scan showed multiple pulmonary nodules in the right lower and middle lobes (subpleural nodules shown at arrowhead in Figure 1). Bronchial brushing and a bronchoalveolar lavage were performed and revealed no evidence of malignancy and yielded no acid-fast bacilli or fungal microorganisms. Because of the suspicious nature of the nodules, a wedge resection was performed to establish an etiology. The only significant past history provided by the woman was mild adenopathy, idiopathic thrombocytopenic purpura, and absence of exposure to irradiation. On gross examination of wedge resection specimens, the pleural surface appeared unremarkable. Serial sectioning revealed a 0.5-cm firm white subpleural nodule of the right lower lobe with an unremarkable bright red parenchyma. Microscopically, there were scattered peribronchial and perivascular lymphocytic proliferations occasionally associated with germinal centers, and foci of monocytoid cells (Figure 2, A), some of which were associated with lymphoepithelial lesions involving the bronchial mucosa (Figure 2, B). These findings pointed to a low-grade B-cell lymphoma of bronchus-associated lymphoid tissue (BALT) type. However, because flow cytometry results failed to reveal B-cell monoclonality among a predominance of reactive T cells, we made a diagnosis of reactive lymphoid infiltrate. Despite the above flow cytometry findings, we performed molecular studies for gene rearrangement with a polymerase chain reaction for immunoglobulin heavy (H) chain to rule out a lymphoma. The differential diagnosis was lymphoma or a follicular bronchiolitis. The latter diagnosis was supported by rare noncaseating granulomas and inflammation of uncertain etiology because the results of acid-fast and fungal stains were negative. When the results of the immunoglobulin H-chain gene rearrangement were found to be positive, indicating evidence of B-cell clonality, we rendered a final |
| Databáze: | OpenAIRE |
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